Latch On NYC: Let’s latch off for a second and consider the repercussions

I’ve written about seven different posts about Mayor Bloomberg’s Latch On NYC initiative between yesterday morning and today, none of which said what I wanted to say.

Finally, At 2am, I fell into a fitful sleep, and had the craziest dream.

In the dream, I am a forty-two-year-old Manhattanite, in the waiting room of a fertility specialist who will hopefully assist me in becoming a mother, after a five-year struggle to conceive. As I wait in anticipation, a nurse comes into the room. She sits down and kindly – yet with an unmistakable, underlying, patronizing tone – asks me if I was sure about going down this path. She informs me that babies conceived through IVF have a higher risk of autism, a 40% higher likelihood of ADD,  and a 42%  higher risk of developing cancer later in life. She explains that nature really intended for women to have babies in their early twenties, and since I’d been too selfish busy to get around to it, it would probably be best for me to forget about it. Considering assisted reproduction is strongly correlated with preterm labor and multiple births, my “choice” is going to have public health repercussions. The choice was mine, but she wanted to make sure that I had really thought it through, and perhaps considered just getting a puppy instead.

“Oh!” she calls as she leaves the room. “I will see you next time – we’ll have this little chat each time you come in for your appointments.”

Then, my dream-world shifts. Now I am a single mother living in a poor neighborhood in New York City. I have to work, and my daughter has to stay with the only childcare provider I can afford – a woman whose idea of stimulation is setting my kid in front of Dora the Explorer. I hate it, but what can I do? I’m sitting in my living room when the doorbell rings. It’s Child Protective Services. They tell me that my child will be taken into custody because she watches far more television than the AAP likes, and plus, children of single mothers are far more likely to end up on drugs or with severe psychiatric disorders. They know it will be painful for me to give her up, but it really is for the best. She’ll be better off in a clean foster home with organic food and no screen time allowed. Maybe I should consider getting a puppy to fill the void.

Once again, the dream swirls around, and now I’m back to being me. I am sitting at a table with a friend and her kids, and she is feeding them hot dogs and cold cuts, with tall glasses of milk to wash it all down. I harshly inform her that plant-based diets have recently been proven to provide numerous health benefits, cutting down on both cancer risk and the chance of obesity. She looks uncomfortable and angry, but I press on – because I know she wants to be a good mom, and if she really loves them, she’d want to do what the studies say is best. After all, I feed my kids a vegetarian diet, and I don’t find it difficult. Look how beautiful and healthy my children are!

But she points out that her kids are beautiful and healthy, too. And while it may be true that plant-based diets are healthier, she doesn’t think it’s that cool that I allow my son to ride forward-facing, at nearly four years old. Don’t I know that recent studies have shown that extended rear facing cuts the risk of severe injury and even death due to car accidents?

And then my vegan son takes a bite of her son’s hot dog, and my friend throws a puppy at me, and I wake up in a cold sweat.

My feelings about the Latch On initiative, where women in maternity wards will be forced to beg for formula each time they want to feed their babies, and lectured on top of it, are quite clear. It’s explaining them that trips me up, because it’s so easy to stumble into tangents about flawed statistics and relative risk, and nanny states, and common sense, and all that nonsense that just gets tempers flaring and gets us nowhere. But you know, my feelings shouldn’t matter. Just like it shouldn’t matter if plant-based diets are better, or we should all get knocked up at 22 to protect the health of the nation, or we should take children out of loving homes simply because the conditions aren’t ideal. What matters is that we need to draw a line somewhere, between advocating for healthier choices, and becoming so overzealous that we set off internal alarms about human rights.

Don’t fool yourselves into thinking that this isn’t a feminist issue. It is, more so than ever. Back when our mothers were diapering our little butts, they were given hell because the studies showed that children with working mothers got the short end of the stick. When our grandmothers gave birth, they were knocked out for the whole experience because of a paternalistic view that our hysterical sensibilities couldn’t handle it. And we revolted.

Where’s the revolt here? Why is it being squashed down, ignored, accused of being in the pockets of the formula industry? Why is it being brushed off as a “mommy war”? Why is no one realizing that our anger has nothing to do with promoting breastfeeding – something the vast majority of us support – and everything to do with concrete, authentic fears about personal freedom?

I keep hoping that women’s rights organizations will rise up, speak up, and stop this insanity. But all I hear is silence.

It’s like a bad dream.

 

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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162 thoughts on “Latch On NYC: Let’s latch off for a second and consider the repercussions

  1. “APPLAUSE”

    Excellent EXCELLENT post. I've been wondering the same thing myself… Natural (or non-knocked out birth) had advocates, working mothers had advocates, WHERE ARE THE FEEDING CHOICE ADVOCATES? Why is no one outraged by this? Yes, we have you FFF and a few braves souls like Hannah Rosin and Joan Wolf, but where is the loud, vocal majority that stands up to this as was seen with the other issues mentioned? This whole thing has gone entirely too far. There is breastfeeding advocacy and support and there is (as the language in the initiative clearly states) limiting choice and access.

    I thought about this last week (I think it was in a comment that was deleted from facebook) and although I'm afraid it's going to sound extreme, I'm going to write it anyway… Have you ever considered starting a formal formula/bottle-feeding advocacy group (other than the blog) kind of analogous to La Lache League? It might sound crazy but if you think about how LLL was founded-women helping women in the face of medically innacurate information, social norms against breastfeeding, downright hostile environments to breastfeeding, uninformed doctors, etc…. Is it really a stretch to say that the tide has turned and it's now bottle-feeding and formula that is increasing falling into what breastfeeding in the 50's was? I see more and more “initiatives” like the one in NYC and the more I'm convinced we need an FFF (along with an LLL). Something to think about…

  2. Having been fighting this since the article came out, this finally brought the tears. Thank you. I am beyond words in my circle–officially blue in the face. I needed this and thank you.

    The silence is deafening. Are we the only ones who get it? Are we the only ones who see the whole thing is rigged?

  3. I agree with Kristin! And, to me, it is insane that many of the same women who feel that women should have a right to choose to have a baby (or not) don't feel that women should have a choice when it comes to feeding their baby. It really is insane.

  4. I live in NYC and formula fed my daughter from day one in the hospital for reasons both personal and medical. If I choose to have another, it's also my choice on how to feed him/her. I am so disgusted and don't know what to do. I want to start a protest outside City Hall to protect my rights, as well as those rights of other women around the city. Stay out of my uterus. Stay off my boobs!

  5. Abby-so with you there!

    I find it so so ironic that New York (and especially NYC) is one of the most pro choice cities in the country when it comes to abortion rights; yet supports an initiative like this one where the choice on how to use one's breasts is more or less completely taken away. Where is the logic?

    Katie from Brooklyn-PLEASE protest outside City Hall. I'm sure you could find other moms who would gladly join you. That type of advocacy and activisim is what this whole issue needs. Visibility into the women who DO NOT WANT these things and a real life illustration into how far these types of things cross the line.

    *Disclaimer to all-I am not intending to argue for or against abortion or start a completely unrelated debate. My point in bringing up the issue was to add context and illustrate the inconsistencies in the policies/overall philosophy of one city.

  6. I love your idea! There was once a website (http://www.momsfeedingfreedom.com) that tried to be a place for moms that formula fed and breast fed, but it was squashed pretty quickly by the lactivists. The person still blogs, but the message boards are dead.

    Moms need support in all their healthy choices. If moms are made to feel guilty and secretive about using formula they may not ask critical questions or access information they'll need to prepare formula correctly.

    • There were problems with the site such that it was partially funded through the infant feeding council (lobby group for the formula industry). That said I believe that the women working for it do believe what they're saying and were adding an underrepresented voice.

      There was something interesting I found on the 'banthebags' site – this blog post
      http://banthebags.org/62

      So they told women to flood that site. I read that post a few weeks ago and am scared there will be a similar push towards theFFF blog and FFF FB page.

  7. One of your best posts! It's something I've believed ever since I've had feeding issues myself: It's a women's right to choose issue. If people have no right to tell me what to do with my uterus, or my skin, or my hair, why should they have the right to tell me what to do with my breasts?

  8. Wow! Just wow! Has anyone been doing a “formula feed in”? the way people do “nurse ins” for protest? This is the most insane thing I've heard in a long time and you've really hit the nail on the head here.

  9. Hey Kristin. I run a non for profit which is dedicated to supporting bottle feeding parents and advocating for them (amongst other things) We are based in Australia (where all that Bloomberg is trying to introduce to NY is mostly already in place – so I can tell you from experience it isn't fun) Even though we are not authorized to conduct business in places like NY (although hopefully some day soon we will be) we would be more than happy to help anyway we can to support the creation of any bottle feeding support/advocacy organization like ours anywhere in the world. Anyone who would like to chat to me can contact me at bottlebabies@hotmail.com
    Just wanted to let you know that your idea isn't, at all, 'extreme' and is happening right now.

  10. This was an excellent post but I cannot agree with the notion that it isn't harmful to have companies marketing products in a hospital. As a mother who was awaken at 2am by a nurse informing me that my son lost 12 oz and wasn't getting enough milk, therefore we “had” to start formula, I am absolutely opposed to direct marketing to vulnerable new parents. I remember being fatigued and guilt ridden that my son may have been hungry for days. I later learned that weight loss was normal during the first week of life but by then it was too late. Breastfeeding became a difficult and emotionally challenging experience.
    Mayor Bloomberg is not saying that new mothers are not allowed to give formula in the hospital but rather, that just like wipes and swaddles and socks and everything else you pack in your hospital bag, you will have to bring it with you if you are going to use it. As a public health professional and also as someone who has seen first hand how virtually all women are able to breastfeed successfully in my country of origin where there is no such direct marketing, I welcome this initiative. I do think there are lots of social issues and disparities that need to be addressed in order to really support breastfeeding but this is an important first step. While I do not believe that formula is evil or poison (I was only able to breastfeed for 5 months), companies do actively engage in marketing strategies that are harmful to families. Nothing in life is free. There is a reason that companies are giving away all these free 'samples' and the reason is hardly altruistic.

  11. Why are formula marketing strategies any worse than any other marketing strategy? A company that sells a product for a profit wants you to buy their product. I've never seen a major protest against Big Dairy for their milk ads, or any other product. If you can avoid purchasing products that you don't want, why should formula be any different? If you don't want to use formula, and you can breastfeed well enough, then don't buy formula. If you want to use formula–even for supplementation—then each formula company is competing for your business and you will buy whichever best suits your needs. I think the vitriol against formula companies and their advertising is misplaced.

    I can agree that individual hospitals shouldn't necessarily be promoting a specific brand, but hospitals tend to make contracts with suppliers and will provide the effective brand that THEY can get for the least amount of money. I think it's more that Hospital A has a contract with Formula company B, than Hospital A is promoting Formula company B over Formula company C.

    If the hospital initiative were simply that the hospital provides no formula (or other things like diapers, wipes, etc), then the hospital needs to tell the expecting women when said women register at the hospital. Then, the woman can bring whatever she needs and feel free to use it when she determines is necessary. But, this initiative says that a nurse/LC or whoever will berate a woman each time she asks for a bottle for the baby. How is that helpful? What if the women DO bring their own formula? Would they still get lectured by the nurses/LCs for not BFing? How many women will smile and nod and attempt to BF while the nurse is in the room, and then bust out the bottle as soon as she leaves? Wouldn't it be better to find out if individual women are interested in BFing and then provide appropriate support to those women, while leaving the other ones alone?

    • I would like to encourage you to research formula, there are clinical differences. Hospitals typically pick formula based on those differences. Especially, Neonatologists… They need to pick the right nutrition to help the littlest survive & grow. I would trust the opinion of those well studied, highly clinical health care professionals. If my pediatrician told me they recommend a particular formula, I would trust them. There are MANY studies out there supporting what I say.

      I agree with your last point 100%! There are already hospitals out there who are certified “baby friendly”, and follow some of the protocols being encouraged by Mayor Bloomberg. But, not all. Very extreme indeed!

  12. I do think that some types of marketing, in certain settings are inappropriate and unethical. For example I am happy that pharmaceutical companies are no longer able to give branded “swag” to physicians. One may not think that a free pen or post-it pad influences what your physician prescribes but research has shown that sometimes those small incentives are more effective at influencing behavior than more sizable incentives. Similarly, I think direct marketing to children is unethical and I support efforts to enact legislation that will put an end to it. There are other examples. I think that there are lots of social changes that are necessary to support breastfeeding and in some ways these solutions taken by themselves are too simplistic, but they are a start.
    No one is saying that formula feeding should not happen in hospitals. I have no idea why this is being interpreted this way. The use of the term “free samples” makes us not acknowledge what it is. It is aggressive, direct marketing and under this initiative hospitals will no longer be a site where this takes place. You can bring with you and feed your baby as much formula as you wish. No one is taking that right from you in the least. If you want to formula feed, bring formula with you. Bring as much as you want.

  13. What does a misinformed nurse have to do with formula marketing products? It's clear that the problem in your situation was a nurse who was poorly trained on breastfeeding. Taking formula away from those who want it does not help this situation at all.

    I did not have to pack wipes or swaddles or socks in my hospital bag. I was provided with everything my baby and I needed for my stay. I didn't even need to bring underwear. I brought some of my own clothes and toiletries out of personal preference but I could have chosen to wear the hospital gown the whole time and use only the soap and shampoo they provided.

  14. Misinformed nurses exist within a context that allows them to remain misinformed. None of these factors exists in isolation.

  15. Ok, I see your point, and I agree that Pharma marketing has influenced doctors and that direct marketing to children is unethical. While the swag bag is nice, it is not necessary and if all “freebies” were eliminated, with the intention that the hospital is not marketing a specific brand, that would be fair.

    I understand that no one is saying formula feeding isn't allowed–but this particular initiative is going farther than eliminating swag bags. It appears that part of this initiative is for hospitals to keep formula under lock and key, so when women ask for it, said women can be lectured that breast is best. That is what I have a problem with, and why I went on the tangent of women bringing formula with them to the hospital. If the women bring formula, will that pre-empt the lectures, since they won't be asking the hospital staff for it, and singling themselves out as “in need of education?” (genuine question, not snark.) If the hospital were simply arguing against giving freebies, then the hospital can make it clear that parents need to bring their own formula (or whatever), and end it there. No lectures. No forced educating–only women who want help with breastfeeding would interact with LCs and hopefully get whatever support they need.

    As a teenager, I remember that sometimes my Dad would lecture me about something, and I would smile and nod and do what I wanted to do anyway. Why would lecturing adult women, who have the autonomy to make their own decisions, lead to more women BFing for longer? If a woman wants to BF and she can, then she will. If not, then she won't. All the lectures in the world will not change the reality that is parenting in America at this time.

  16. Misinformed nurses exist within a context that allows them to remain misinformed. None of these factors occurs in isolation.

  17. Amy M I do agree with you there that there is the potential for shaming and discrimination particularly among groups that are presumed to be ignorant and at a higher risk for mistreatment to begin with (low income mothers, teen parents, the uninsured non-english speakers etc). Shaming is not the way to go but supporting the natural, default, optimal feeding method IMO should be what happens in the 2-4 days that a woman spends in the hospital. That can be done without shaming but education is indeed necessary at all levels.

  18. You can train health care professionals without restricting formula to those who want it. The two are not related. But taking away formula is easier and cheaper so that is what is done.

    Formula marketing, coupons and samples, has been illegal in the UK for over 15 years. Looked at their breastfeeding rates lately? “Overall, only 35 per cent of UK babies are being exclusively breastfed at one week, 21 per cent at six weeks, 7 per cent at four months and 3 per cent at five months.” That's actually WORSE than the US. SOURCE: http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/UK-Breastfeeding-rates/

  19. This is ridiculous. Moms who want to formula feed will stil be able to formula feed. This initiative will help those of us who might otherwise have had nurses shoving formula down our babies' throats, despite our wishes. It will help educate moms so they can make the best decisions for their families.
    Melanie

  20. I am a big fan of this blog and of formula – as someone who breastfed my son for 14 months, but combo fed for 8 of those, I could not have sustained our breastfeeding relationship without relying on formula – as supplementation for the first 5 weeks and then to stretch my pumped milk supply for longer than it would have lasted once I went back to work.

    Yet I am also confused by the interpretation here of this initiative, specifically the idea that there will be some kind of enforced shaming lecture if a mother requests formula. Reading through the FAQs you linked to, there is nothing like that required as far as I understand – this is not like all the anti-choice legislation passing nationwide requiring women to listen to false or coercive information before they can have an abortion, for instance. These FAQs are quite clear that formula will be provided upon request or as medically necessary; in fact, this initiative appears to be aimed at hospitals, not mothers.

    Having given birth in NYC and knowing many other women who have, including some variation across class and ethnic lines, I think if public health officials want to increase breastfeeding, they are correct to target the maternity and pediatric health professionals at the frontlines, and leave women alone to make their decisions. We can't give women credit for being able to make informed choices despite formula marketing and yet act as if they will be somehow coerced into breastfeeding against their will because that formula is slightly less visible (not less available).

    Like another commenter, it was a night nurse who basically freaked out my husband and I – new, exhausted parents – in the middle of the night telling us about our son's weight loss and the need for formula supplementation. My personal reaction was that if I didn't comply I was knowingly starving my son. So we started supplementing and it took until 5 weeks for us to achieve exclusive breastfeeding. In hindsight, I wonder if I had refused if the nursing relationship would have clicked faster, but honestly, my milk didn't come in until Day 5, my son was a lazy nurser, and supplementing with formula took some of the pressure off. It was a big help and I'd do it again, I think.

    Now, my son's caregiver, a South American immigrant to the US, had to fight the nurses to breastfeed her son. It what sounds like a heavily racialized interaction, they kept trying to keep her from her son while they took care of him in the NICU (he was born at term and was in the NICU for jaundice, I believe) and she really had to work to be able to breastfeed him.

    Finally, a wealthy white friend of mine in Manhattan who is very passionate about breastfeeding was very clear with her docs/nurses that formula should not be given under any circumstances, and it wasn't.

    As a researcher, I should not be relying on anecdata here, :), but it really seems health professionals have a heavy influence on breastfeeding success – that's why we're all up in arms over WHO and AAP guidelines, right? So I guess being ticked at Bloomberg over yet another effort to restrict formula marketing is…in line with that, ?, but I am genuinely confused about the interpretation that women are going to be shamed from this hospital-targeted initiative. I actually think this initiative makes sense if municipalities are interested in increasing breastfeeding success, and it strikes me that it is aimed at the nurses and other health professionals who think they know what is best for us mothers.

  21. “How many women will smile and nod and attempt to BF while the nurse is in the room, and then bust out the bottle as soon as she leaves?”

    I would SO do that. I'll never forget the LC who balked at me for even considering pumping before 6 weeks. Not supportive at all.

  22. I also think it's important to consider whose interests the hospitals should be serving – namely, their patients. In this case, mothers and their infants. Yes, mothers may come in with information and plans (as many of the FFF Fridays demonstrate) but are the hospitals in line with our plans? Or are they trying to make sure they don't have overstocks of Similac and Enfamil threatening to expire on their shelves? Or trying to keep their operating costs down in part by accepting and distributing free supplies? I read an article or post several years ago about Disney marketing to new moms and frankly it just seemed so crass and invasive. They are not selling anything lifesaving or nutritious, and it is such a private and emotional and special moment in our lives, those first few hours and days with our children, and recovering from the physical and mental intensity of giving birth. And I need some free Mickey Mouse stuff?

    Corporations generally do not have the public interest in mind. Many will deliver a superior product or practice good corporate citizenship as the smart and high road to profitability, but unfortunately too many are unscrupulous and pursuing low road practices such as delivering shoddy products (such as the formaldehyde laced-trailers FEMA unknowingly purchased and warehoused Katrina survivors in, or the toxic Dalkon Shield IUD that the company's Board knowingly kept on the market despite it killing women), or exploiting workers (Walmart, companies who knowingly hire undocumented workers) or violating or flouting health and safety laws (agribusiness/CAFOs, I'm looking at you). As mothers and consumers, we have the right and intelligence to move about the marketplace freely and choose how to feed our children, and we still have the stated power, at least, to make these choices in the first moments of our child's life. But I don't need my night nurses or hospital lactation consultants or other mothers or pediatricians making those choices for me, nor coercing me to sway one way or another – and it is the health professionals who are vulnerable to coercion by the formula companies by accepting the free swag and then passing it on because they have to get it off the shelves or because they think they know what is best for us (and sometimes, as experts they do, but only in as much as they listen and communicate and dialogue with us about our needs). I think public health professionals trying to keep a healthy distance between corporations and the medical professionals who care for patients is the right intent.

  23. Leigh, the news reports have been quoting sources from the Bloomberg camp who have explained that women will be “educated” about the impact of their choice every time they request a bottle. Whether or not this will actually happen is up in the air, but that is what people are freaking out about. I agree that the FAQ don't spell this type of policy out, but it does state that “Mothers who decide to formula feed and cannot afford formula will be referred to WIC (Women, Infants and Children), a food and nutrition program for low-income families,” which worries me, as many women don't qualify for WIC; it also states that hospitals “must restrict supplemental feedings to those indicated by the medical condition of
    the newborn or mother”, which worries me because who decides what qualifies as a medical condition worthy of formula; and that “it is recommended that all feedings – breast milk and supplemental feedings – should be documented by nursing and physician staff. When a breastfed infant is given formula, both nurses and physicians should document the medical indication for supplementation, including the content, volume and method used…When the decision to supplement is not medically indicated, efforts to educate the mother should be documented as well by the nursing and/or medical staff.” Further, the initiative recommends “storing formula in a locked location, such as a storage room, cabinet or an automated medication system or, storing formula in a location outside, but reasonably near, the maternity unit…(and) limiting the number of hospital staff with access to formula by implementing a system to identify which hospital member accessed the formula supply; some examples are a log book, a code or a key system.” This worries me because they are now treating formula like a controlled substance, and that does send a dramatic message to mothers – you are essentially going against medical orders if you opt to formula feed. And being that breastfeeding must involve breasts, I DO think it can be equated with other anti-choice movements out there which tell women how to use their bodies.

    But all of that? It just WORRIES me. Probably not anything to get up and arms about.

    THIS is what I am reacting to: “If the mother still insists on receiving formula, document it in the chart along with the
    reason and distribute only the amount of formula needed for the feeding.”

    This is not mother-shaming. It goes far beyond that. This is essentially policing how we parent, and how we use our bodies. Granted, it may sound worse on paper than it is in practice, but from the horror stories I've been hearing from women who've given birth in baby-friendly hospitals, I don't expect to feel, in hindsight, that I was overreacting.

  24. Yes, but by the same token, hospital staff can be coerced just as well (if not more) by threats of losing jobs because they are not following protocol. If a hospital administrator will lose funding b/c they are not in compliance with the BFHI, it stands to reason that nurses will be feeling the heavy hand of these policies and worrying about every bottle of formula they give out. Considering they need to document each one, on a report that will go to the city….

    Also, I think what you are arguing for is more in line with banning the bags, or educating hospital staff on breastfeeding-friendly protocols. I agree that there are healthcare professionals who push formula onto women, or mishandle breastfeeding problems. Locking up formula may indeed stop this from happening, but we can't ignore the negative side effects of such a policy.

  25. This. Is. Not. About. Marketing.

    This is about putting formula under the same kind of lock and key that restricted drugs are placed under, and institutionally-supported bullying of moms at. every. freakin. feed. into breastfeeding.

  26. Tell me Shikki, do you shame people who need glasses or contacts? Do you think people in wheelchairs should be educated about the natural, default, optimal way of getting around? Do you support “educating” couples dealing with infertility about natural, default, optimal ways of having a baby?

  27. FFF, this post is epic! Thanks for speaking out about this.

    As for suggesting moms who want to FF bring their own formula, American hospitals feed every other admitted patient. And there are usually a couple different items on the menu. I don't see why new moms should be limited to one option for feeding their baby. Yes, I know some medical professionals frown upon bottle/ formula feeding. But some doctors aren't crazy about vegetarianism either, and it does take some effort to have a vegetarian offering at every meal. Nonetheless, vegetarians are accommodated. Maybe you're sitting there thinking, “But breastfeeding moms come with their own breasts and milk. Why is it unfair to tell formula feeding moms to bring their own stuff?” Well, hospitals who support nursing moms and babies properly spend time helping them breastfeed. So even though they don't supply the actual meal, they do indirectly spend time and money (through staff's wages) feeding breastfed babies. Suppose for a moment the situation were reversed. So, hospital staff would assist moms and babies in breastfeeding, but each time they would give moms a talk about the benefits of formula. I would expect a massive protest. And rightfully so. I do not think people would be saying, “Mothers can still breastfeed. If they don't like the hospital's policy, they can hire a private doula, nurse, breastfeeding counselor or lactation consultant to help them.”

    Also, I do think the talk before each bottle is meant to shame and/or manipulate formula feeders. No, discussing the benefits of breastfeeding is not necessarily criticism of formula. But if somebody (hospital nurses in this case) keeps going on and on about why it would be good do do things differently (breastfeed) every two to four hours, I could only conclude they disagreed with what I was doing (formula feeding) and trying to change my ways. And asking somebody to do something (like breastfeed) after they've said “no” once or twice is not respecting their answer, IMO.

    Note: I'm not anti- vegetarian or anti- vegetarian menu options. I think most of the objections to vegetarianism in the medical community come from cases where it's not done properly. i.e., Some people just stop eating meat and animal products and don't re- balance their diets to make up for it. I realize there are plenty of vegetarians who educate themselves on nutrition and eat very healthfully.

  28. I agree that swag bags or using samples from only the two biggest formula companies as part of a marketing program can be problematic. But it sounds like your experience was one of a medical professional who was not properly trained and this business of hiding formula from new mothers and refusing to tell them it could be an option for them goes to the other extreme of stupidity. In my experience, my baby lost enough weight the first two days that the ped told us we might want to consider supplementation, and as new parents who hadn't dreamed of having to stock up on formula or had the time to research it, we were grateful for the nursettes (only later did I discover premixed is the most hygienic way to go for newborns). I didn't even pay attention to the brand name. It was a medical decision. If marketing is the concern, how about requiring hospitals to put white tape over the brand name and/or adding the cost of nursettes/formula to the hospital bill? I wouldn't particularly mind that, unless the parents were uninsured and poor. There has got to be a way to respect people's different needs and choices without making it all about marketing.

  29. I read the guidelines too, and thought that for the most part they were sensible in not offering formula unless requested by parents or doctor and basically respecting the choices of parents instead of pushing the formula option – however, two aspects worried me, one: the bit about not providing formula unless medically indicated (though previously they say they want to respect feeding choice), and two, the bit about continuing to “educate” the mother about BFing and “encouraging” her to talk to more LCs even if she says she wants to at least partly bottle feed. This goes against the previous emphasis on respecting choice. If the state can find a way to limit formula marketing, perhaps by having a budget line for buying generic formula for use by newborns, they could separate their fear of marketing from their commitment to women's choices.

  30. I agree, though would like to add that at the NY state hospital where I gave birth, the feeding booklet distributed to parents was written by LLL and at least one colleague who had also given birth there said she was afraid to say she wanted to bottle feed because of bullying by pro-LLL nurses. Pressure on new parents is a delicate matter and can come from all sides. And those who work in maternity wards should get a good education on the pros and cons of various feeding methods from sources other than those who are ideologically or financially committed to one side.

    On the question of who is making the choice for a new parent, I think it's unavoidable that we will rely somewhat on medical pros. E.g. I had no idea that over x % of weight loss in the first two days is something that indicates supplementation could be useful. My ped was sensitive and good about giving me the information and allowing me to make the choice without undue pressure and answering my questions/concerns about nipple confusion and whether I could still make BFing work. Medical pros should be well trained and give patients as much information as possible and trust them to make the right choice. Only in rare cases is the child's life actually at risk from a parent's misguided choice (e.g. FTT) and then the pros can be more heavy-handed.

  31. To clarify: the reason I'm concerned about the provision to not provide formula unless medically indicated is that the doctors or nurses may get to overrule or bully a woman who states that she wants to FF for whatever reason, and requiring a “medical certification” essentially cancels out the woman's right to choose for herself. That, and the provision that you should keep on urging and 'educating' a new mother when she has stated her own preference, contains the potential for bullying and a paternalistic undermining of the woman's right to decide for herself. Just as docs in the old days gave women injections to dry up their milk without their consent, could docs now refuse 'medical certification' to use formula? That's what worries me.

  32. This whole “hide the formula” initiative by a male billionaire may seem like a small thing that won't limit access to formula, but at the end of the day it is limiting an availability that was once there by adding hoops.

    So swag is banned – sure no evil marketing. Let's make it harder to get it in the hospital (with a lecture no less each time to see if the mom is truly “informed”). Oh but you can bring in formula to the hospital great… but you're unable to get nursette bottles so you need to bring your own formula and bottles, but there's no place to properly prepare and store equipment and formula.

    Let's see how else can we ensure women have time to understand the gravity of using formula. Since it's a medical product it should only be sold somewhere where there is a pharmacist on duty – hey most grocery stores have a pharmacist on duty for at least part of the day so if you're organized you'll have some and you still have the choice to use formula. They do this for products that can be made into crystal meth, so hey it should be done for formula.

    Wait, the pharmacist can't speak with you about your choice unless it's behind the counter so let's move it there. Women still have the choice to use formula, no one is taking that away. Dang those lines are long with women waiting to pick up  formula, so maybe we should make it by prescription only..

    wait the lines are still long but now it takes longer for women to get the formula. It's not like formula is banned, we just want women to have thoughtful conversations with their medical provider about getting formula prior to actually using it. Again be organized and ensure you have regular appointments and you'll still have access to formula.. no one is denying anyone the choice to use formula.

    Too many prescriptions are being given so let's put in a mandatory 24 hour waiting period before you can use your prescription (and there is a 2 can of powdered per prescription limit)- this gives time to reflect on your choice to formula feed. You can still get formula and choose it as long as your doctor approves and you wait 24 hours and get there at a time the lines won't be horrendously long and when a pharmacist us on duty, and having to go to the doc to get new prescriptions and then thinking about what your choice.. This isn't about restricting your choice to use formula and restricting access to it….oh wait…

    (yes I know I'm being over the top here).

  33. Hi! Lenore from Free-Range Kids here, whose book has a whole chapter on how bottlefeeding is just fine. (And some posts on my blog and elsewhere saying same.) Would love to interview you immediately for an oped due in a few hours. Please email me your phnoe number at heylenore3@gmail.com . Thanks and great post! L

  34. I don't shame anyone. I was a formula feeding mother myself who only breastfed for 5 months. You're comparing apples and oranges here. People with medical conditions/disabilities are not the same as the vast majority of women who are able to breastfeed. For those with medical barriers to breastfeeding, that is something that needs to be diagnosed and documented by medical professionals anyway. My issue with this discussion is that people have gone into fear mode to the point that extrapolations are being made that have no basis in fact and are bordering on actually spreading misinformation. While there are people on here who have no problem minimizing my experience as just one bad nurse, people don't seem quite so quick to dismiss and chalk up these individual stories of “formula shaming” everyone keeps referencing to one misinformed/uneducated health professional. You can't dismiss one woman's experience while extrapolating the experiences of others to some chronic systemic issue that must be advocated against.

  35. The part where you decided on your own that it is not about marketing with no explanation as to why that is. As a public health professional I see people find a way to make every health intervention about individual choice and shaming and often allow themselves to be used and manipulated by corporations. Companies are in the business of turning a profit, so to say that a discussion of marketing has no place in the discussion of a setting in which a product is made available is baffling. There are lots of smokers who would tell you that this is not about marketing also and who claim that smoke-free initiatives are all about shaming people who are unable to quit.

  36. Everything else that's given out in a hospital is documented. Why shouldn't this be documented? How does a documentation and data gathering on which mothers choose to use formula automatically harmful?

  37. Setting aside the marketing argument, I'm curious about this: “People with medical conditions/disabilities are not the same as the vast majority of women who are able to breastfeed. For those with medical barriers to breastfeeding, that is something that needs to be diagnosed and documented by medical professionals anyway.” What if someone decides that BFing is not something that fits with their family needs or work or is just not for them, e.g. if they are not comfortable with a child at their breast – would you argue they must receive a medical notice in order to show they have a right not to BF? While I strongly support a well educated medical staff that knows how to advise new parents on what works or doesn't re: BFing, there are many non-medical factors in the decision to try, not try, continue, not continue, etc. Who decides who “is able” to BF?

  38. While I don't think formula is poison or anything crazy like that I do think hospitals generally follow guidelines in order to provide what is considered to be the most healthy food option for a given type of patient. If I'm hypertensive I won't get a meal with salt; if I'm not into healthy food and I think the hospital food is not what I prefer to feed myself I can't ask request a Honey Bun and Doritos for dinner and say that I've been shamed because I had to ask and was subsequently denied the option that I wanted. Similarly if the AAP's guidelines indicate that breast milk is optimal for a newborn, that should be the hospital default. The hospital won't prevent me from giving my child formula just as they won't prevent me from eating what ever tasty treat my family brought for me to eat that day. I just think that there should always be a voice for those who are most likely to be affected by any action, that being said that advocacy should be grounded in facts not fear.

  39. If you know that you will not breastfeed bring formula with you. You won't have to ask for anything then.
    Just like there are women who don't want to give birth vaginally and choose an elective C section or Jehovah's witnesses who will not receive blood transfusions under any circumstances, you inform your provider of your personal choice and work with them to also inform the hospital staff what will and won't happen during your stay. There are lots of examples of patients not choosing the default option for reasons that may not be medical.

  40. I did not “know” that I would not breastfeed exclusively, and many women here didn't plan for supplementation, but that's another matter. Let's say someone knew from the outset they wanted to FF. I get the impression that formula given to their babies would still have to be documented and go through the same vetting as free formula – correct me if I'm wrong, those who have read the policy more closely than I. The impression I get is that it's not so much about asking people to pay for their own formula to limit marketing, and more about ensuring health professionals do all they can to get women to BF

  41. The intent is to support breastfeeding by actually providing support not samples of another option for women. It's like if I'm trying to eat healthy. I go to a meeting at noon. There is a spread of healthy wraps. I grab one and I'm able to stay on my diet. In contrast if there was a spread of healthy wraps but also a spread with cookies, brownies and cake, in which scenario is it going to be harder for me to eat healthy? Sure if I really, really want to stay on my diet I can just ignore them but for most mere mortals it's going to be a tad harder to do so. This initiative is like putting the cookies, brownies and cake in the vending machine down the hall. The option is still there but it is easier to do the default.

  42. Advocacy should indeed be grounded in facts, not fear. Comparing formula to doritos and cigarettes, as you've done backhandedly at various points in this thread, is not grounded in fact. If AAP says breastmilk is optimal for a newborn, so does everyone say a vegetarian diet is optimal for adults (see original post?) That doesn't mean hospitals should bully people into eating veg or BFing. It's not comparable with salt for hypertension, more like offering a patient a chickpea-spinach soup vs a chicken-noodle soup. One is more balanced and healthier but both are pretty good forms of nutrition. Optimal vs pretty good is not the same as safe vs. unsafe.

  43. So what you seem to be saying is, if someone says they want to FF for whatever reason, one still tries to hide the formula and show them the 'healthier' option? I have to say that comparing formula to cookies in a vending machine sounds a bit paternalistic – it's life-supporting nutrition for children who cannot eat anything else for the first six months, but you want to tell parents who choose this option that they are essentially hooking their kids on junk…it's an old, familiar scare tactic. You sounded reasonable at first but I'm afraid you're sounding less so now.

  44. I've said repeatedly that I do not consider formula poison and was a formula feeding mother. Some of you are so determined to fall into one of two polarized groups on this issue that there is really no room for real dialogue as no minds will be changed. I am simply challenging the idea that there should be no limits to the extent to which a hospital must support an individual's choices in that setting. There should be no shaming of any kind in any medical setting but the assumption that shaming will occur by default because a hospital is not simply supporting all individual choice is flawed. It is clear that many have not even read the language associated with this initiative and sadly don't care to.

  45. You are making all of these crazy extrapolations about formula being junk food as you are assuming that this is how I view formula which I have said repeatedly is not the case. I guess everyone will latch on to the assumption that I'm calling formula junk food and go from there. As someone who works in health promotion this idea that every setting must simply support all of our individual choices is flawed IMO. You can feed your child whatever you please. This initiative in no way shape or form takes away that right.

  46. Just as an aside, I have a lot of nurse friends working in NY hospitals, and when it comes to the ones who've been at this a while, I have a suspicion that they'll quietly give Bloomberg's initiative the finger and keep going as they've always done. But that's really only because the few I know are strong women who really don't want to be involved in someone's personal feeding choices, and view their job as one in which they help individual mothers do what they want with their babies. Maybe I'm just hopeful…

  47. Shikki, if you think these are “crazy extrapolations” please read your own comments. You are the one who brought up the junk food/vending machine/doritos/brownies comparison – it's right there in your comments.

    There is no 'polarization' here. I breastfed longer than you did, if you must know, and strongly support BFing. I also strongly support FFing (I supplemented around 20%) and people's right to choose. And if you want to support those who truly want to BF, it's best to put more money into continued lactation consultant support, better train nurses and hospital staff to quickly diagnose and offer support for things like tongue tie, and lobby for longer mat leave, IMHO, not treat formula in hospitals as the problem. While I strongly support educating hospital staff so they don't undermine mothers who are BFing or want to BF, and particularly like the BFing mothers' bill of rights in this initiative, it would be nice if the initiative also considered any mother's rights and didn't just act as if everyone else's choices didn't deserve equal respect and support. Requiring hospitals to limit access to, monitor, and repeatedly attempt to re-educate women who are FFing is not = respecting and supporting their decision. It's paternalistic to think that the mere sight of samples is going to change someone's mind, or that women are too weak to know how they want to feed their own children. If someone lists their preference in the hospital as BFing, of course they should not be given unwanted samples of formula; if they ask for the formula, they should have access to it. This initiative wants to give only hospitals the right to certify the “deserving formula feeder” as one who has a medical “pass,” despite the lip service paid to respecting a family's choice and there's the rub.

    I do find it disturbing that night nurses in your case and Leigh's pressured you into supplementing when you were not ready, but losing 12 oz in the first two days is, with an average 7-8 lb baby, above the 10-12% of body weight that the AAP itself says indicates supplementation 9http://www2.aap.org/breastfeeding/curriculum/documents/pdf/Hospital%20Breastfeeding%20Policy_FINAL.pdf) . Everyone should have the right to make the decision to supplement or not with adequate time and information and not scare tactics. But I'm not sure the medical advice would have been different in other circumstances…FWIW.

  48. Very true! I work in a world where there is only 1 “baby-friendly' hospital in the state, but this state has one of the highest BF rates int he country out to 6 months. It's because the nurses are supported through education, and they support the moms in a positive way.

  49. Maybe this is about marketing…. for Mayor Bloomberg. Coincidence he has been in the news for this, gun control and gay rights recently??? I think not. You're right, formula companies have nothing to do with this argument. 🙂

  50. If you took my comments as a comparison of formula to junk food and tobacco then I can't help your interpretation. I clearly stated and reiterated my intent in several posts. My son was born at 8lbs 14oz and delivered by C section so supplementation would not have been recommended for him for various reasons. Additionally, I was told by the nurse on the next shift as well as our pediatrician that they should not have done that. Again, why is my experience diminished and assumed to be uninformed but all the formula shaming experiences are assumed valid?
    I have stated that think that this is a good start but that it is too simplistic. There are women who will indeed begin breastfeeding in the hospital as a result of these efforts but will go home to find inadequate socio-cultural support to continue. I get all of that but I take issue with this micro-level discussion about shaming that's largely rooted in fear with little evidence to suggest that shaming is the intent of this initiative or that it will occur as a result.

  51. I was pointed to this sight by a friend, and I can really appreciate everyone's points. There are some things that need to be cleared up, however (I feel). As background, I work in this world of BF, hospitals, formula choices, etc etc and have for years across this great country of ours (free speach and all) 🙂

    Some of you have already pointed out this argument is not about formula and formula companies, and I agree. But, to those who have mentioned the marketing tactics of formula companies, were you aware there are U.S. and WHO code laws that govern the companies? One of the big three is a pharmaceutical company, so they fall under even stricter regulations in terms of marketing. I am afraid, others do not bother to follow the rules… I will give the example of not advertising on TV, which is a WHO code violation, but 2 companies do it anyway. I will also encourage you to read the “Sunshine Act” which is intended to curb HCP spending by companies, and call out the HCPs who take advantage. I encourage you to do the research, if you are so inclined, and you will find the differences in marketing and ethical practices between companies. Our hospital chose one company because of their commitment to BF, the billions they spend on supporting BF, and their commitement to us to help increase our BF rates through education (that we can't afford because of cut backs).

    HCPs like NICU dieticians and Neonatologists make clinical evidence based nutrition decisions daily to help the littlest ones who need it the most. I challenge those who have said hospitals choose one formula over another because of contracts, etc etc. In the world of today's economy, contracts are important, but in the end, the clinical opinion of the staff counts also. If my pediatrician said, I prefer XYZ brand because of this, I would take it to heart. It is unfair to lump good people with the FEW bad.

    The “baby-friendly” initiative has been going on for years. It started at Evergreen Hospital in the Pacific NW. Since then, hundreds of hospitals have followed suit across the U.S. Here's the deal on that. JHACHO rates hospitals on their BF rates. The government gives kick-backs to hospitals who are certified Baby Friendly, not to mention the prestige in the community and marketing opportunity to be certified. The intentions are good (increase BF rates) with negative outcomes (pressure mom) because it isn't done right, like so many of you have already pointed out. The movement is spreading, more and more hospitals are in the process of becoming baby-friendly across the US. It's the hospitals interpretation of the rules that will determine how succesful it becomes.

    I work in a state with only 1 certified hospital, and one of the highest BF rates in the country. In my opinion, it is a combination of culture in the community, and positive help from HCPs. Nurses are well trained on the subject, and it's a positive experience.

    Let's talk about WIC, mentioned earlier. A couple of years ago, WIC changed their food package so that less formula was given the first month of life, but more fruits & veggies are offered, to encourage BF. WIC only has so much money to spend/help each person, it isn't unlimited supply! Jury is still out on whether this initiative is working, however.

    My past point, does anyone think it's weird that Mayor Bloomberg comes out with these crazy statements all the time? This isn't the first thing he's publically spoken about that is controversal. Is it really just HIS marketing technique?

  52. What about diapers? There were a ton of Pampers brand diapers in the hospital where I gave birth. What do I use now, over a year later? Pampers! Should we be asking for only cloth diapers or at the very least generic? Are there groups out there saying that these diapers are a detriment to society and an environmental nightmare and hospitals are contributing to it? Why is it the marketing argument only comes out when it is directed at formula, but with diapers we stay silent? Hey, I want to keep those diapers there, and the formula for that matter, but if you are going to make that argument, think about all sides.

  53. Looking at the other side of the story…..
    Disney is not goverened by the U.S. FDA and PhRMA Code guidelines, which govern the interaction you mentioned. Did you know one of the formula companies mentioned above spends over $3mill a year to operate a 3rd party, non-branded lactation hotline for free? Our state shut ours down, and no hospital runs a 24/7 one, so how would a BF mom get help at 2:30 in the morning? I don't agree with all of your argument, but do agree in your overall point, no one would be able to influence me if I did or did not decide to BF. I'm insulted for all of my nurse and doctor friends who you feel are so easily coerced, however. They are intelligent, highly educated people who can make decisions (either way) on the information and clinical evidence provided. It's not like the company sales reps are going in and saying “here's a cookie, now use my product”. Google infant nutrition clinical studies, and you will find all of the research that has been done. If it wasn't for the “companies” research, we wouldn't know what we know about BM, and people could still be feeding their babies Karo Syrup and Goats Milk

  54. The last time you stayed in the hospital what was the brand of the bed pan they used? Who made the tubing for your IV? What about your sheets? Who made those? The fact that you don't remember is not because those products were generic but because they were not actively marketed to you. Just because you slept on sheets in the hospital and will again in your lifetime, you weren't sent home with a free fitted sheet with the brand embroidered on it. A hospital can choose whatever products to use with patients including the brand they diaper babies with. There's a difference between a hospital's brand of choice and giving a bunch of samples of branded merchandise to patients.

  55. I live in NYC, had my son at an NYC hospital and may very well have future children in NYC hospitals. If the Mayor wants to do this, then he needs to actually walk through the halls of one of the hospitals in NYC and see what actually goes on. Not even the public hospitals; the ones with nicely decorated maternity floors, state of the art monitoring systems, and the track records of being great places to give birth and have a wonderful birth experience (whatever that means). Now go to the post-partum floor and take a look at the nurses who are overworked, overloaded with patients, and undereducated on breastfeeding support. That was my experience. I asked one of nurses for help and she settled the baby on my very new and painful c-section scar, grabbed my boob and my baby, and mashed the two together. There, you are breastfeeding! That was the support I got. I asked for a pump (not that I knew what to do with it), and it was wheeled in and the nurse walked away. I had no idea what to do, didn't know why my baby didn't want to nurse at 12 hours old, and just wanted to sleep because I was in pain and physically and emotionally exhausted. That was the start of my breastfeeding experience with my son. Needless to say, it went downhill from there. I truly think that I would have had a complete breakdown if there wasn't formula around.
    I will HAPPILY explain this to every nurse, doctor, LC, social worker, and politician who tries to lecture me about formula when I have my next child. I'd even be willing to do it before that time. NYC FFs — care to join me?

  56. We must think of the NICU babies in these instances, where mother's milk alone is not adequate, or multiples, where mom can't make enough milk and they need to be supplemented. I also think of babies with GI issues who need special formula to digest. All of these instances need to be considered.

  57. I agree with you. There is a definite difference. What I am saying is not about brands, it's about the type of products we choose to protest. I don't see people protesting Pampers, just formula brands. I was sent home with a whole unopened pack of Pampers diapers, Johnson and Johnson soap, and I think a small tube of Desitin. All marketing, all very specifically targeted, and all appreciated in a single-income household. I am all for swag bags, coupons, etc. Bring it on. I know how it is used and directed and if I wanted to change the products I use, I would and did. (My son's skin didn't do well with J&J and I liked Butt Paste over Desitin, FWIW) The point I'm trying to make is that if people are going to get upset over marketing, get upset over ALL marketing to parents, not just the formula.

  58. He's a politician. Of course his causes are part of his own branding. That doesn't negate the fact that he has been a leader on several issues that public health professionals can only dream of moving on in other states. I live in Connecticut and our smoke-free legislation would have never passed if New York hadn't taken the lead and successfully implemented smoke free policies of their own.

  59. Well there's nothing evidence based to suggest that one method of pampering a baby is better or worse than another so there is nothing to protest in that regard. I threw away all the Johnson and Johnson stuff I got at my baby shower because there was a lot in the media at the time about the potentially dangerous chemicals they used in their baby products. At the individual level I'm right there with you. I love free. I took one of those $5 off coupons to BJs every time we bought Similac. But taking my individual household out of the picture and acknowledging that my education and social supports make me less vulnerable than lots of other women, I think that there are some policy changes like this one, that if implemented carefully and successfully have the potential to do a lot of good for the public as a whole.

  60. Shikki-first off let me say that I think the sorry excuse for breastfeeding support you received in the hospital was awful and I totally understand why you feel the way you do.

    However, when considering evidence of whether one choice is better than another, we as patients have the right to know the background behind the strength and consistency of that evidence, and the real actual contexts of the research results. This is not happening with breastfeeding research and definetly not happening with the message disseminated to the public. Before I became aware of this issue, I, as a childless unmarried early 20-something who was eons away from considering getting pregnant actually believed (based on the “breast is best” message) that there was indisputable scientific evidence that breastfeeding/breastmilk prevented a whole host of health problems, ranging from the short term minor problems all the way to long term health issues seen primiarly in adults. THIS IS NOT ACTUALLY THE CASE! The real story is that breastfeeding vs. formula feeding has been shown to confer relatively minor benefits (especially at the individual level) over formula feeding with results that are based on methodolgically weak research and conclusions that are NOT CONSISTENTLY FOUND. Not to mention the host of other factors that cloud the research (self reporting, publication bias, reverse causality, confounders not adjusted for, residual confounding even after adjustment, etc. etc. etc.).

    That is not to say that breastfeeding isn't in fact better than formula, it is! But the message being sent to the public is misleading and at times blatantly false (i.e. “a baby is NEVER allergic to its mother's milk” my nephew is living proof that this one is not always true). Beyond that, formula is now being touted as dangerous and harmful when it is in fact a valid, healthy choice. That is the issue in a nutshell. There is no context around any of this and women truly aren't being given the chance to make an informed choice when they are being misled into thinking breastfeeding is a cure all and a must do if they want healthy children when in reality it's not.

  61. Part of the issue here is that people have misinterpreted breastfeeding research and what research can and cannot do as a whole. You will never find causality in observational research. Hell there isn't a study to date that is going to tell you that smoking CAUSES lung cancer. It doesn't exist and it would be unethical to prove this using an actual experiment. There is however overwhelming evidence however of a strong ASSOCIATION between tobacco use and cancer risk. The most you can find is association and so breastfeeding cannot cause or prevent anything any more than formula can. Breastfeeding is simply associated with lower risk of certain adverse health/developmental outcomes. That is not the same as breastfeeding preventing those health outcomes, nor is it the same as saying that formula use will cause those outcomes. The misinterpretation of existing data by the public does not negate the fact that breastfeeding has it's benefits for mother and baby. It's the same way people misinterpret what BMI tells you. People think that if you have a high BMI it means you're unhealthy right this minute. No it means your RISK of certain adverse health outcomes is higher. It's the same here with breastfeeding/formula. People give all these ridiculous anecdotal examples about how their formula fed baby is just has healthy as a breastfed baby. That anecdotal evidence has nothing to do with overall risk/benefit.

  62. I completely understand what you're saying and actually agree. However, it doesn't change my original point. The message being sent to the public is not one of relative risk or real context, they are being told in no uncertain terms that breastfeeding provides significant, causal protections against the risk of a broad range of health outcomes and that formula is dangerous. Neither is true. I don't deny that the benefits of breastfeeding for baby/mother are real. However I do think the strength and magnitude of those benefits is completely exagerated by the gov't, medical associations, and others in a position to exert enourmous influence over people. Also, for the parallel that you draw to smoking and lung cancer, I don't think it's comparable to breastfeeding research despite that they are both observational. From what I understand, the statistical strength in the observational studies between known, causal relationships (such as smoking and cancer or drunk driving and vehicle death) is significantly numerically stronger (double digit odds ratios) in comparison to the statistical relationships between breastfeeding and a positive health outcome (oftentimes odds ratios are not even higher than 2). From my limited understanding/memory of basic stats, odds ratios of less than 2 should be interpreted with caution due to confounding (I would say 90% of all breastfeeding studies I've seen has an odds ratio of less than 2). Bottom line-I think the message getting out to the public and the actual reality are very different. I don't think there is enough of a difference in the outcome of a breastfed vs. formula fed baby that it justifies locking up a perfectly valid choice and berating a new mother with a lecture everytime she choses a bottle.

  63. The strength of the association may not be as strong but is valid nonetheless. Everything that is not the default option in the hospital will require extra effort for a patient to access it and again if you think you might not breastfeed you can bring formula and bypass hospital staff altogether Keep your baby in your room and give him/her the formula of your choice. On one hand people seem to view health professionals in a positive light but when it comes to this issue this same group is transformed into this abusive, intolerant group. I don't quite understand the overall cynicism or the dual perception of hospital staff.

  64. What I would like to know is, what is the “impact” of their choice? Not to beat a dead horse, or rehash “me,” but I was FF in 1980. For all anyone knew, Similac had lead in it. As a child, and despite being a preemie, I missed THREE days of school from kindergarten through high school for illness. I was a honor roll student and got a PhD at 25. I'm very healthy and have been within the “ideal” weight range my entire life. I'm also a pretty nice person. I guess that, since I am only 32, I still have the rest of my life to see the “impact” of formula, but the most immediate impact was that it sustained my life…and let me grow to live a pretty good one! Sure, there's a chance I could become diabetic or something like that, but who's to say that was caused by the Similac. At 17.5 months, and despite having his skull rebuilt, my son is doing wonderfully! He's advanced in every area with the exception of speaking. And, that's related to his birth defect- not how he was fed. Until someone can show me what the negative impacts of formula are and PROVE that they are related to formula feeding, I think a lot of this is BS. Gastro issues happen with babies. SIDS happens. All sorts of bad things happen. But, I would stake money that a can of Enfamil was rarely the cause.

  65. “Public policy needs to take a stand on and work towards the collective good, or common good – something that overall benefits society, and is just and equitable – therefore filling in the gaps to assist the “have-nots,” the more vulnerable among us, the disadvantaged, however you wish to characterize people. It is a blunt instrument and will alienate some who wish to have more “freedom” to make the choices they want to make, especially those of us with the financial, social and material resources to do so.” Interesting point, and I generally agree on the need for public policy to help us work toward the public good and not descend into libertarianism. However, the science shows that for the most part the differences between BF and FF infants/children are pretty small after accounting for SES/class/confounding factors. It does not therefore seem to make a great deal of sense to use our limited political and social organizing capital to lobby for things like reducing formula samples in hospitals, but rather to lobby for the things that do seem to make more of a difference to children's health outcomes, such as better access to health care and better mat leave/child care. And I see a great deal of energy expended by elite women on the question of how less elite women feed their children, and efforts to blame all kinds of sub-optimal outcomes on FFing or other, later feeding choices (fast food and what have you) and it rings not only of paternalism but also victim blaming – it's up to poor families to accept “education” and when they realize how much better BFing/eating vegetables is for them, all our social problems will be solved. How does that change the fact that poor families have little time or incentive to cook, or change the stress in their lives that makes them (as it makes all of us) reach for sugary fatty foods? It's easier for preachy liberal elites to shake their heads and admonish the poor for their choices than to think about what it would mean to help them overall. FWIW, look at the BFing rates in France (not high) and the health and educational outcomes of children there (pretty darned good). All things considered I still think it's a good idea to educate as widely as possible about the benefits of BFing. It's when the blunt instrument of public health mandate is used on something as sensitive as an individual woman's physical and life situation that may or may not make BFing ideal for her that I start to worry. The idea that these policies are better for the “less informed” or people who may “water down” their formula is paternalistic if you don't stop to consider for a minute whether “those people” have a single freaking weak of paid maternity leave and can afford to BF.

  66. Great post. Having both bf and ff my baby I have often wondered if mishandling of formula brings down ff babies associated health outcomes in studies. I wonder about this especially in the first few months of life. If the idea is to feed on demand then one has to be very careful. Having plenty of money to feed the baby, it was still hard to pour an mostly untouched bottle down the drain. I can't imagine doing this on a budget. I think the temptation to stretch the bottle past an hour or water it down is a major problem. I think WIC limiting formula to mom's is awful: “Feed on demand, but you better get when they are hungry correct or they will really be hungry”. I don't think it is an issue of improving bf in poor neighborhoods at all costs. These are the women who often need to bottle feed the most if they are working or going to school or, as is often the case, both. If they aren't then yes of course it is nice to breastfeed and they should be supported 100% if that is what they want to do. Icck, I get chills thinking about a mom who has to go back to work in 6 weeks, had no idea she was supposed to bring her own formula and having to make a case for her situation each time she needs to feed her baby. That seems like a system set up to instill guilt and recriminating thoughts should baby end up not 100% healthy the first year. Maybe it wouldn't be so bad if they were also given a copy of Joan Wolf's, Is Breast Best?

    I would be pissed if my baby lost 12% of its body weight in the first few days and the night nurse didn't wake me up to inform me of this. That said of course they should tell people what the norm is and what the threshold of acceptability is and what the choices are, i.e. talk to the pediatrician on staff if you are opposed to formula feeding etc…

  67. I suppose it's a hazard of arguing with strangers on the internet to throw my words back at me to suggest I'm someone I'm not. Unless I'm misunderstanding the quoted bits in relation to “preachy” “liberal” “elites”.

    It's not about auditing individual choices – that gets us nowhere or leads us down the wrong paths, to welfare reform to punish “welfare queens,” to revisit again the welfare example. What should matter to progressives, I would hope, is ACCESS to equitable resources – money, information, time, education, housing, jobs, etc. – so that we have a chance of reducing inequality. For example, now there are so many more greenmarkets city-wide, and they take food stamps and electronic benefits cards. Are NYC residents mandated to shop at them? No. But can millions more residents get fresh produce IF THEY WANT IT, yes. The same for parks. We have endless work to do to make safe, quality open space more accessible in the city, but there have been millions invested in making parks and playgrounds across the 5 boroughs cleaner and safer and just increasing the overall #s of parks and recreation space.

    I don't get arguments that assume that because we're discussing one thing – Latch On as a policy instrument, for example – we're de facto not concerned about other issues or not advocating for them or don't see this issue as one of a larger bundle of issues. Of course, higher wages, better family leave policies, easier transit to good jobs, more equitable and high quality public education, safe neighborhoods, quality and affordable housing and a variety of other things would improve low-income household's life chances, quality of life, and economic security. But the original post here on a blog about infant feeding choice focused on Latch On, so that's what we're discussing. As it stands, just last week in NYC there was a rally for a minimum 5 days paid sick leave for workers. There is a living wage bill stalled in the City Council. Domestic workers in the city successfully lobbied in the last year or so for time off. All of this activism is happening and is important, for breastfeeding rates and overall good maternal and child outcomes. Yes, Bloomberg should be doing much more to support all those policies, and perhaps we should all be sitting here strategizing about how to make that happen. But we're not talking about all that right now, are we? I missed that, if so.

  68. For what it's worth, I didn't feel ready or not ready to supplement with formula when the nurse got all alarmist on me. (I think my relationship to breastfeeding and formula feeding can best be described as ambivalent. 🙂 )

    But once some nurse told me, a new mom who didn't know sh*t about being a parent yet after only 48 hours in my new role, in the middle of the night no less, that my son was losing weight, and there was a nutritious, caloric substance that would help him, my personal reaction was of course, I don't want my baby to starve. As it turns out, it took my son 3 weeks to get back to his birth weight, so formula was a godsend while we worked on the whole nursing thing.

    It was more like the nurse expecting me to make some kind of quick, sensible, informed decision in the middle of the night all sleep deprived and dazed and bewildered and new at this, and in the face of what she clearly considered the sound medical solution to be, which was formula supplementation. It's like, ok, yes, I'll do what you suggest. Whatever it takes.

    My worst experience in the maternity ward was with the LC; she had the worst bedside manner, touched me without asking permission, and didn't listen to my concerns. She was the worst and I avoided all BFing help at the hospital after that for the rest of my stay.

  69. So a close friend of mine worked on getting this initiative off the ground for NYC (I was just reminded of this on FB). Here is a link to an article she co-published in the Jnl of Urban Health about formula marketing in hospitals and initiating breastfeeding that was part of her research and part of the city's impetus for pursuing this policy.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443254/

    Check out Table 1 in it as well: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443254/table/Tab1/

  70. I was expressing a general frustration with the focus on 'educating' women to make better choices, which as we've discussed a lot on this blog, can attract a great deal more popular enthusiasm and energy than more tricky macro problems like maternity leave. And because so many of the studies on children's health outcomes say that correlation with higher SES explains a lot of the benefit that is observed with BFed infants, it's still frustrating to see LLL and most leading advocates for babies/feeding focus on telling mothers what to do differently when that is either not possible or not really the basis of the problem. I agree COMPLETELY with you on making sure people of all soc-ec groups have the choice or opportunity to live in a healthier way, and I really strongly support the pro-BFing parts of the NY initiative. It's the part where they want to institutionalize lecturing women who don't want to BF, or to treat women who choose to FF as if they are jonesing for a controlled substance, that gets me. I did not mean to direct the vent at you and apologize if I misread what you said.

  71. Someone stated this above and it's taken me a while to figure out why it strikes me as misguided: “The intent is to support breastfeeding by actually providing support not samples of another option for women.” I don't see why “actually providing support” – of the kind that was clearly lacking for Abbi above who has used an NYC hospital – has to mean refusing women access to or knowledge about “another option.” It's not the samples that are at issue, the policy FAQs suggest that any formula, no matter how obtained, will be dispensed pretty much as medication would be, under strict supervision, because women may be led astray by the sight of it. I really do worry that it's just much easier to pick on formula as the bad-guy when the reasons why women who would like to BF cannot do so would take much more work to resolve. Also, is this initiative for NY state backed by more funding for LCs? That is something I think we would all like to see and could agree on as “providing support.”

  72. Who has diminished your experience? It sounds like your nurse was wrong and I strongly support the BF-support guidelines that would stop him or her from supplementing without your permission or without need, and that would honour your wishes as the mother. Actually, the part of the mayor's initiative that is pro-BFing rather than anti-FFing is actually great IMHO

  73. OK, actual good news that I was unaware of in the Affordable Care Act due to kick in across the US tomorrow – LCs will finally be required to be covered by insurance. This is great, and counts as “support” more than anything I've seen all year – now let's hope more hospitals hire them as a result and more women can get continued access through the first month or two of BFing (and while we're dreaming, can insurance companies please also be required to cover the Neocate that nearly bankrupted me): http://www.hrsa.gov/womensguidelines/

  74. Hi AmyM, marketing to new parents is an unethical act because new parents are considered a vulnerable population. Parents are sleep-deprived and experiencing a total life change. Placing infant formula in front of them while they are trying their best to breastfeed (maybe to a point unsuccessfully) will sway their decisions unwantingly to formula feed. These marketing practices have been proven to work, which is why formula companies want to market like this. Its different than just any company advertising their product. It is unethical.

  75. Shikki-I'm responding to your last post here because otherwise our posts will become pencil thin and too difficult to read.

    Again, nothing you're saying here is wrong and I'm not suggesting that the strength (or lack of strength) in the relationship invalidates it, not at all. However, I am saying that the strength and context of the message about the benefits of breastfeeding that is getting out to the public is completely disproportionate with what the evidence is actually saying. DOes that mean people should be told there's no difference between breastfeeding and formula? Absolutely not! I understand why breastfeeding is officially recommended and it should be. However, people should NOT be mislead into thinking that breastfeeding will prevent or even significantly reduce the risk of a broad range of problems (because it won't). They should be given an accurate, realistic message about what it can and cannot do-and that is NOT happening!

    Surely there are other parallels in the hospital and with medical treatment and procedures where one is “optimal” and another might have some small disadvantages but is still a pretty good option if the first is not possible/feasible/desired. Does that mean that option should be hidden away or come with a “talking to” every time it's opted for?

    I also don't understand your point on the dual perceptions of the hospital staff and don't think anyone on here has said anything remotely indicating that this is how they feel.

    I also disagree with making breastfeeding the “default” for everyone. As we've all seen from the numerous personal stories and posts on this forum, it is most definetly NOT the best default option for everyone.

  76. Completely agree. Breastfeeding MIGHT prevent a baby from getting one gastro infection or one ear infection in the first year of their life-MIGHT. I can see how on a population-wide level this is significant from an overall health and cost savings perspective. But for an indivdual weighing their own personal pros and cons-I could totally see why this would not be enough to keep struggling with breastfeeding or lengthen a workday to pump, or whatever it happens to be.

    I'm also largely unconvinced that breastfeeding in and of itself has much significant to do with SIDS prevention. I think there are too many unknowns with what the cause of SIDS even is and too many other correlations. Not to mention the laundry list of other things someone can do to lessen the risk of it. Even the revised AAP statement officially recomending breastfeeding as a preventative measure for SIDS is cautious (the language around breastfeeding is notably more tentative than any of the other recomendations around smoking, vaccinations, back sleeping, etc.). This is purely my own speculation but I'm not 100% convinced that the decision to include breastfeeding in the SIDS statement wasn't coming from some political/institutional pressure (one of the researchers of a large meta-analysis (Hauck I believe) is also a key member of the AAP's breastfeeding task force, or something like that. I could be totally off the mark here, but I found that very interesting.).

    I guess I can blame my horrible allergies, occasional B grades in school, being overweight as a kid and in college, and my occasional cold/ear infection/stomach bug as an infant/child on the fact that my mother supplemented me.

  77. Leila do you have links to research papers to support your statement? I've been that sleep deprived parent three times over and it certainly didn't make me reach for the formula. Other factors such as refusing to latch, lack of wet diapers and a screaming hungry baby at 2am when no LC is going to pick up the phone made me reach for the formula. and you know what I did at 8am?
    I picked up the phone and called an LC for assistance. My daughter never did latch properly but it wasn't because of formula. We just did not have a successful nursing experience.

  78. I think daycare plays more into infant illness than the method of feeding. My formula fed kids stayed with my mother every day while I worked and had minimal illness up until they started pre-school at the age of 3. My friends who nursed and had their kids in public daycare experienced more illnesses and even stated that as the reason for the illnesses.

  79. Some weight loss is normal, but excess weight loss is dangerous. Moreover, the pattern of the weight loss, when it stops, when baby begins to gain again, baby's output are all important variables. Some babies DO need to be supplemented early on for their own health. 12 oz is a very significant weight loss, certainly nothing to sneeze at.

  80. It is not about marketing because the marketing elements of the ban are NOT what has people riled up. It is about women having to be lectured for each and every bottle of formula they request for their newborn.

  81. My concern is with the locking up, which is over the top, and with the “When Mothers request Formula” FAQ:
    “What do we tell our staff to do when mothers (families) request infant formula?
    While breastfeeding is healthier for both mothers and babies, staff must respect a mother’s
    infant feeding choice. Educating mothers and families about breastfeeding and providing
    encouragement and support, both prenatally and after birth, is the best way to ensure
    breastfeeding success in your hospital.
    While in the hospital your staff can:
    • Assess if breastfeeding is going well and encourage the mother to keep trying.
    • Provide education and support to mothers who are experiencing difficulties.
    • If the mother still insists on receiving formula, document it in the chart along with the
    reason and distribute only the amount of formula needed for the feeding.
    • Train staff in breastfeeding support (CLC, IBCLC) who can be available to assist new
    mothers at all times regardless of day, night or weekends.”

  82. “I am simply challenging the idea that there should be no limits to the extent to which a hospital must support an individual's choices in that setting. “

    But no one has claimed this. People have claimed, based on the actual, real differences in health outcomes between breastfed and formula fed babies (which are still very much in question on some issues), restricting the use of the only appropriate source of nutrition besides breastmilk is overreaching and over the top.

  83. Thank you for saying this, I tried to say it above but you did it much better. Losing 12 oz is a significant amount. And FWIW, the AAP recommends breastfeeding intervention with greater than 7% weight loss and supplementation at 10%. Even the Academy of Breastfeeding Medicine states that a 5-6% weigh loss is the normal maximum, and over 7% requires intervention with breastfeeding interventions to be tried first. Moreover, one has to be alert to signs of dehydration. The baby's health is dependent on being fed.

  84. There was an article recently published online about the WIC changes. It found that the number of exclusively breastfeeding packages went up, and the number of partial breastfeeding packages went down, but the number of exclusively formula feeding packages also went up. Basically, it just shifted mothers out of the partial breastfeeding group without changes in overall breastfeeding rates. http://www.ajcn.org/content/early/2012/07/25/ajcn.112.037622.short?rss=1

  85. Ok, let's accept the point that marketing has a place in the discussion. Why then, don't breastfeeding advocates (as a whole) concentrate on marketing tangible ways to solve breastfeeding problems? I see alot of great ads that promote the benefits of breastfeeding, but I never see many resources that point in the direction of solving breastfeeding problems. Let me be clear: I don't mean just latching and poor supply. I mean hotflashes, intestinal cramping, hormone fluctuations, workplace pressure, etc. Taking the available population of women who have even 1/2 a chance of breastfeeding, where is the follow up service? In the case of NYC, if there is going to be a public health policy geared toward breastfeeding, why not set aside public (or even private, gasp!) funds to set up a more structured support system? I couldn't afford a private lactation consultant, and when I contacted the hospital LCs they stated that they were “simply there to help with latch on problems.” I am educated, I reached out for help and the help wasn't there. How is it that we have more research on erectile dysfunction than for something as important as breastfeeding? Why not direct your voices to that instead of pressuring post partum women to do something that is so daunting for even the best in the beginning?

  86. There are a number of studies showing reduced breastfeeding rates associated with formula samples.

    http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2006.103218
    http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002075/abstract;jsessionid=0D939D0BFFC7FCC9C219E2F2EBF4B28D.d01t04?systemMessage=Wiley+Online+Library+will+be+disrupted+on+4+August+from+10%3A00-12%3A00+BST+%2805%3A00-07%3A00+EDT%29+for+essential+maintenance&userIsAuthenticated=false&deniedAccessCustomisedMessage=

    So, really yes there is pretty consistent evidence that formula sample packs influence mother's behavior. That's why I think it is important not to focus on the “no free formula” angle. Stopping formula samples is entirely in keeping with the evidence.

  87. I've seen a couple of suggestions knocking around the internet the last couple of days concerning this very idea. Is anyone serious about doing such a thing? I am in the wrong part of the world and my daughter's too old for bottles anyway, but I think it would be brilliant. Get the media involved….

  88. Moms Feeding Freedom was funded by formula companies. Not that this means it is horrible, but it doesn't potentially bias the info.

  89. People are upset that they cannot receive free formula at the hospital without a special request. The reason that it has been so readily available and given out undocumented up to this point is because hospitals are an important site for advertising formula to new parents and locking them in as consumers. I really wonder why people think all these samples are available in the first place? Because companies just love giving away free stuff? If you want unlimited formula for your baby, bring lots of formula with you. It's not that hard.

  90. Whether or not my son needed supplementation is not up for debate. Supplementation was not appropriate in our particular situation as I have stated previously. This was already discussed with our medical team.

  91. The use of formula will not be restricted in hospitals. You can bring as much as you want or ask for as much as you want. People act like they're raising their child in a hospital. You're there for 2-5 days max. You are free to go home and formula feed to your heart's content.

  92. Ladies I know that you all probably have medical degrees from the University of Internet and know more about my baby and situation than I do but my pediatrician confirmed that supplementation was not necessary for my baby as did subsequent nursing staff. I really don't mean to be nasty but supplementation was inappropriate in my situation. I'm not asking if it was, I'm telling you that it was. Further there are lots of stories about families being awakened in the wee hours and being alarmed in this way.

  93. A-frickin-men. Could not agree more. If this initiative comes with more funds and training for better LCs, great. If it simply browbeats mothers and pushes hospitals to lecture them without support that's simply obnoxious.

  94. “People are upset that they cannot receive free formula at the hospital without a special request. “

    No, this is false. I don't think that you are actually reading what people are saying. People are upset that 1) formula will be locked up and restricted like a controlled substance and 2) every mother who requests formula will receive “breastfeeding education” with each request, and then will only be given one bottle at a time.

  95. That may be very well be true. I am only commenting because I sometimes see breastfeeding advocates say that supplementing for weight loss is never necessary, or explain away 10% weight loss as not a problem. This is dangerous advice.

  96. And every time you ask for formula, you will be lectured on why you aren't using it. I don't understand how people don't find this offensive! I'm a breastfeeding mother and I think it is absurd.

  97. Yeah, we were told 10% but I mentioned 12% because that's what LLLI says may be the outer limit based on various factors like fluid absorption so, not knowing the original poster's situation and not wanting to assume, I went with the far-conservative estimate.

  98. PhD and not the University of Internet, sorry to disappoint, but I can read studies. I'm glad you found a ped and hospital that took your individual needs and preferences into account. In the case of many of us, we needed supplementation two days in and I'm glad we had formula samples available for the doctors to give us because there was no way after waking to feed every hour and recovering from a painful vaginal birth that I was going to run out to buy formula as you so compassionately suggested further up. Here's to hospitals supporting all of us in our choices and needs.

  99. Shikki, I believe that you were the one who brought up smoking and junk food. If you didn't intend a comparison, you shouldn't have brought them into the conversation.

    I do hear what you are saying about your experience in the hospital. I agree that if you were given bad advice, that was wrong. If you were poorly treated or coerced, that was wrong. I believe that medical staff should be trained to support breastfeeding, and not to undermine breastfeeding, and hospitals and health care providers should followed evidence based guidelines on supplementation. I also fully agree that health care providers and hospitals should not be engaged in advertising for formula companies, or even for other pharmaceutical companies.

    I do not believe that the benefits of breastfeeding over formula should be exaggerated. While conclusive research is difficult to do, some very well done studies, such as the PROBIT randomized breastfeeding intervention study, cast doubt on the validity or extent of many of the claims made for significant benefits in developed countries. Given what we know now, while breastfeeding should be encouraged, we can't say that formula feeding is unhealthy, we can only say that it is not as healthy as breastfeeding. There isn't good evidence of significant long term differences. The evidence doesn't justify treating formula as a controlled substance, and it doesn't justify “education” before every requested bottle.

  100. This formula is also not the sample bags and is therefore not free. Have you ever seen a hospital in the US give away anything?

  101. Totally agree. My co-workers' exclusively breastfed babies who go to daycare ALL are sick all the time. FWIW, I did not attend daycare as a baby (watched by grandmothers in my home and their homes) and I still got fevers and colds despite being largely breastfed with some supplementation. There is so much more to it than what the baby is eating.

  102. Excellent, excellent post. Thank you. A theme I've seen continually in the reaction to the Bloomberg initiative is that there is a fear/rejection/etc of a scenario in which a new mother has to “justify” or ask a nurse or other medical professional for formula. I'm currently 32 weeks and plan to FF exclusively. I'm just curious from other moms — what kind of pushback can I expect from the nursing or other hospital staff when I communicate this and ask for formula? I've been told there is a “lactation nazi” at my hospital. I'm fairly confident in my ability to tell her to get the F out of my room, and to be unequivocal with the other nurses and doctors in my intention to FF. I'm not the “smile and nod” type. But am I being naieve? Just want some realistic notions of what to expect – is this going to get ugly? 😉 Thanks in advance for your help and input! – MG

  103. Someone please explain to me how the new rule regarding formula (i.e. having to go through a lecture regarding why breast is best every time you ask for a bottle of formula) is different in legal or principal than the Texas law (recently overruled as unconstitutional) that required a sonogram and an explanation of the fetus on the monitor before an abortion. WHY is this NY guideline not considered as invasive and outrageous as the Texas abortion law? – Melissa

  104. Yeah, I annoys me to no end that people seem to think BFing support means discouraging the use of formula.

    Also, are these hospitals going to hire more nurses… or whoever distributes formula? Because I think between fetching every bottle from a locked cabinet outside of the maternity ward, the additional record keeping and the little talks about the benefits of breastfeeding with every bottle, they're going to need them. And it would be a terrible waste of funding and nurses' (or whatever other staff do this) talent, IMHO.

  105. Ok I finally got around to reading the links and while I see the citation of the samples as an influence there were so many other factors involved that I'm not sure the relation is as substantial as has been reported. But I could be wrong. 🙂

  106. Where did I say that a woman would have to leave the hospital to go and get formula post-partum? I said that a woman in New York who wishes to avoid what many perceive as a “lecture” can bring formula with them to the hospital going forward. Look my issue here is that those who oppose this initiative by and large have resorted to a great deal of fear mongering that have no basis in fact. That is irresponsible. That is all it boils down to for me. People on various message boards are suggesting that hospitals are trying to ban formula use. That is false. People are saying that women will be shamed every time they ask for formula. There is no evidence of that, neither is there any evidence that more robust support for breastfeeding will not be included in this initiative. Everyone does not have to support this initiative I get that, but my issue is and will continue to be that in opposing it, many who have not read the language and who are projecting a lot of baggage around their own choice to formula feed are actively spreading misinformation and creating paranoia. Mothers who choose to formula feed and the orgs/bloggers etc who represent them/us are important stakeholders who can find more constructive ways to ensure that certain considerations are addressed in the implementation of this initiative. We are better than that.

  107. I hope these folks can remember there are people like me who breastfed because my wishes to formula feed and have the hospital provide formula to me was respected and accommodated by the staff in my hospital.

  108. I apologize if somebody has already raised this issue. I haven't read all 118 comments, as much as I love you ladies for writing them. 🙂

    I believe there is at least some talk in the blogosphere about having a positive birth/ hospital stay experience. And I definitely think it's a worthy endeavor, regardless of how your child is born and fed. I do not, however, think this initiative would help moms who use formula to that end. First of all, moms could look forward to a lecture before every feeding. Then there's the time between a infant's huger cues and actually getting a bottle.

    This scene keeps running through my head:
    A newborn babe starts to get hungry and fuss. The mom buzzes the nurses' station and asks for a bottle. The nurses are busy, so it takes a while to get said bottle. (I don't mean to be critical of nurses. I know you are often ridiculously overworked. And sometimes you do have more pressing matters than a hungry baby to attend to, working in a hospital and all.) By the time somebody arrives with the formula, the baby is screaming. But wait, Little One, we need to have a talk about the benefits of breastfeeding first– even if Nursey has to shout it over your cries for food. If Mommy wasn't upset before (having to listen to her precious baby cry and cry), wait until her little “breast is best/ normal” speech. The baby picks up on the tension in the room and wails all the more. After the nurse finishes, “educating” the mom, he/ she makes some notes. Then the baby, who is about to blow a fuse at this point, can eat.

    U.S. hospitals generally use RTF nursettes (sealed, shelf-stable, disposable baby bottles pre-filled with liquid formula). Parents could just be given a stash of bottles to keep in their room feed their baby whenever the need arose. And they could be given a log sheet to fill out if there were a need to record feedings. I don't have children yet, but I think being subjected to a situation like the one above (completely unnecessarily, in my unprofessional opinion), perhaps several times per day, would create a lot of annimosity.

    Think about the atmosphere in a “Latch On NYC” hospital. You'll have a bunch of royally p*ssed off formula- feeding parents, and understandably so. It's not hard to imagine these mamas and papas lashing out at the staff. Even if the staff don't agree with the policies, they may start to resent formula feeders because of all the procedures they have to follow. And because I'm guessing moms won't take kindly to being told about the benefits of breastfeeding (which they've decided not to do) between six and forty-eight times (every two to four hours for one to four days) during their stay. That's not a pleasant way to spend the first days of your child's life. And what an awful work environment! In short, FFF, I second your notion to think about the implications “Latch On NYC”. Or maybe you'd rather not… it isn't pretty.

  109. I did not bring formula with me because I believed that wonderful pre-partum course I took that said BFing would be easy and natural and everyone produces enough. If you had ever been in that situation or can imagine being in it, a little compassion may be warranted. I have read the language around the initiative and as I said, love the parts about supporting BFing and raise my eyebrows at the part about dispensing formula like medicine. If you're going to throw around terms like “spreading misinformation” and “creating paranoia,” the wide-eyed golly-gee why does everyone get worked up line doesn't work. Saying something barbed and then running back to deny you said it (the comparison to smokers feeling shamed or patients having to run out for their doritos fix, e.g.) is getting a bit old.

  110. oh, I agree that there could be some definite confounding factors, or other issues going on. It is a pretty consistent correlation, though. There have been a couple RCTs supporting it.

  111. I have seen some misinformation, but when I quoted the exact parts of the initiative above that bothered me, I was simply ignored. You aren't facing the fact that some of us have read the guidelines from the initiative's website, and still strongly oppose it.

  112. You are being deliberately obtuse and everyone can read and interpret my previous posts so I'm unphased by your ridiculous interpretation of what I have said. On the issue of hospitals being to accommodate individual choice I used examples where this is not always the case in every setting. Similarly, as far as how formula can sabotage breastfeeding I also gave examples of situations where the availability of a less healthy option can have similar results. You are free to interpret my posts however you wish and if taking the most extreme interpretation of my posts works better for your agenda then have at it! None of this changes the fact that when this discussion began folks were throwing around words like shaming and making other extreme statements about what would happen with this initiative and there was no evidence of these things. Yes many statements thrown around were false and I gave examples of those. There is a difference between expressing concern and having an emotional response that has no basis in fact and which goes to the most extreme possible outcome. The discussion has tempered since it first started and people have gone off in other more reasonable directions and expressed valid concerns. Others have chosen to dig their heels in in one way or another. I think the former group will add more constructively to this dialogue going forward than the latter.

  113. I'm not sure what parts of your previous posts were ignored and by whom but I have no problem with mothers challenging some of the language of the initiative. Hell I would like more clarity on several parts of it. I simply feel that if you are going to challenge the initiative, challenge what's actually in it, as is. That is not the same as putting a negative connotation on all parts of it for example interpreting receiving breastfeeding information as being subjected to a shaming lecture; or interpreting the fact that formula is locked up (like all other hospital supplies are) as treating patients like junkies etc etc. Putting a negative spin on the language of the initiative and then asking people to defend how those things are ok is not going to move us out of the place of just an emotional response with no basis in fact.

  114. I was born in 1949 and breast fed. As I was growing up my mother disliked me intensely and I disliked her just as much. We fought like cats and dogs and I feel sure that if she were still alive today, we would feel the same way about each other. Also, I have allergies, asthma to beat the band and I chose to bottle feed my children. I could not stand the thought of having a kid latched to my chest for at least a year or more. I am much closer to my sons than my mother ever was to me. Also, I have a deceased twin brother who contracted infantile paralysis and died at age 4. I had tuberculosis as a child and many other things including malaria. I have 9 grandchildrn six of whom were breast fed and I can tell you that the breast fed ones had colic, upset stomachs, cried and whined more than the bottle fed babies. Also the breast fed kids don't seem to be any closer to their parents than the bottle fed ones. In fact the bottle fed ones seem to be able to relate to other people better and they acclimated to school much faster than ones latched onto their mother's chest day and night. So why is breast feeding superior?

  115. We read your blog posting with interest and wanted to respond and address several inaccuracies. The initiative does not require hospitals to “hide” or “lock up” formula, nor does it restrict access to it for those who want it. Parents who want formula will not have to convince a nurse to sign it out by giving a medical reason. Parents can and always will be able to simply ask for formula and receive it – no medical necessity required, no written consent.

    For 3 years, New York State Law has required that mothers be provided accurate information on the benefits of breastfeeding. The City initiative does not require that mothers asking for formula receive a lecture. The article erroneously dismisses the positive health impacts of breast feeding for which there is there is overwhelming evidence — supported by national and international health organizations. For mothers, breastfeeding reduces the risk of breast and ovarian cancers. For babies, breastfeeding reduces the risk of ear, respiratory and gastrointestinal infections, as well as asthma.

    The American Academy of Pediatrics has just published new guidance to pediatricians in Feb 2012, reaffirming its support for breastfeeding: http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html

    Ultimately, our goal is to support a mother in whatever decision she makes when it comes to nursing her baby and this initiative specifically is designed to support a mother who decides that she wants to breast-feed by asking participating hospital staff to respect her and refrain from automatically supplementing her baby with formula (unless it becomes medically necessary or the mother changes her mind).

    Bottom line: It does not restrict the mother’s nursing options in any way – nor does it restrict access to formula for those who want it.

  116. Another cracking post! Having exposed my kids to all of the “risks” in the post (single mother, tv, hot dogs, the whole stinkin' lot of it), I am now waiting for the knock on my door and for a social worker to investigate…

  117. I am new to the blogoshpere, so pardon me for not reading all 130 posts ……but Fearless Formula Feeder …. I realize that I am very different than you. I want to be informed prior to making a decision, even if the information is difficult to hear. I never want to make a decision or choice – based on ignorance. I have been an avid feminist since before you were even born and I take my rights as a woman and a mother very seriously. I also know a lot about the Latch on NYC Initiative and know that friends and colleagues from across this nation are envious that we have such a forward thinking mayor willing to put policies in place that support ALL women and babies. Yes, Fearless Formula Feeder – ALL women and babies. Did you know that 90% of the women entering maternity hospitals in NYC intend to breastfeed, and yet only one week after leaving the hospital only 53% are actually breastfeeding and only 31% are exclusively breastfeeding at 2 months of age? What about these mother's rights? Don't they have the right to expect their decision to be respected and honored? You sound like a passionate and compassionate person – so I bet you do think these women have rights as well as those wanting to feed infant formula (for whatever reason). But here is the problem – in many, many many cases, mothers enter the hospital telling everyone who will listen that they want to breastfeed and do not want their baby to receive formula- even carrying the “My Baby is Breastfed” card – and what happens – their baby gets formula. You cannot undo giving formula – and YES – even one bottle of formula makes a difference. So what is wrong with putting formula in a safe, secure storage cabinet and require that it is logged out and only issued to the baby if the MD requests it based on medical need or if the mother requests it – just because she wants it? I think this becomes a baby safety issue. Do you know that there have been many cases of infant formula recall? If your baby was receiving formula in the hospital, wouldn't you want to know if the bottle your baby received was in the “lot” included in the infant formula recall. When formula is just given out – with no record keeping – I assure you – you wouldn't know. For heavens sake – these days even ice packs or bandaids and even pillows are kept in a secure area and inventoried. Also Fearless Formula Feeder – what is wrong with getting education and counseling to assist a mother in her own desired goals? Mothers coming into the maternity hospital stating they do not want to breastfeed – do not get repeated counseling contacts, but those who indicate they do want to nurse their baby get information, counseling and assistance – not lectures. What could possibly be wrong with that? And finally, Fearless Formula Feeder – I have searched …. believe me, I have read every word of Latch on NYC numerous times – and I for the life of me cannot find where it says that woman are “forced to beg for formula”. Please tell me where it says that because I cannot find that statement or even that inference anywhere. All I see is a women's right to have a healthy baby and to feed her baby either by breastfeeding or formula feeding, after making an informed choice.

  118. Shikki, I was just reading some of your posts and you are right on the ball. Sorry to say, but infant formula companies are not altruistic. They provide free formula for one reason and one reason only – to instill brand loyalty and create a need (in the mother's mind) for formula. They undermine the mother's confidence and subtly market their product. The infant formula industry is a multibillion dollar industry and have well funded lobbyists. Have any of you seen the new “designer” formulas? They are ridiculous. But, this issue is not really about formula or breastfeeding – because the evidence is overwhelming in support of breastfeeding – for both mother and baby. It is about the mother having the right to have her infant feeding decision respected and followed. Latch On NYC ensures that that will happen.

  119. Listen up ladies….your breasts were created to feed your children. Formula is synthetic. It is second best.

    Most women CAN breastfeed! Choosing not to is selfish! Ppd is not an excuse, there are natural methods to help, breastfeeding being one, placenta encapsulation is another.

    We live in a greedy country, why give my baby the best when someone else will give me free formula(wic) and if I don't use it all, I'll sell it on Craigslist. Extra money to live your “freedom ” lifestyle.

    What happened to being a mother, and giving your baby the best? You're selfish if you don't breastfeed. Plain and simple. If you were not ready to slow down, you should keep your legs closed. If you can't raise your baby without day care, shut your legs. YOU ARE YOUR BABIES LIFE! ACT LIKE MOTHERS AND GET THE BOTTLES OUT OF YOUR BABIES MOUTHS

    • Listen up lady…..our bodies were also designed to conceive and carry a child. Not always the case. So if I have a child by adoption, is he second best? I cannot believe you came here with nothing but your stupidity and anger to offer.
      Not one person here has to explain how they feed their child. Nor should ANY woman be told she doesn't deserve to become a mother unless she is an over privileged stay at home mom who only defines being a good parent by her feeding choices. I would love to see karma come looking for you. If you came here to start a riot, I can't wait to see what unfolds on you. You are the kind of person who makes people hate (not fear) lactivists.
      Speaking of keeping things shut…there is a large hole with two lips YOU need to keep shut. You will find it right under your stuck up nose.

  120. I don't know if everyone has seen this yet, but the NYC website has been updated with a Myths & Facts Doc. http://www.nyc.gov/html/om/pdf/2012/latch_myth_fact.pdf
    According to this document parents who choose to formula feed won't have to jump through hoops to get the formula. I guess it remains to be seen if hospitals will actually implement according to the guidelines that are stated both in the initiative and the myth docs.

  121. Judy, your thinking is flawed. Big time. I assume your mother's anger was from the loss of her young child more than you being breastfed. As for bf babies being more colicky, that's just ridiculous. Don't attempt to ruin a breastfeeding relationship between your grandbabies and their mother's because you didn't have the ideal relationship with your mother. You're spewing nonsense

  122. Personally I agree with you that women's breastfeeding goals should most definately be respected and supported 100%. I think what concerns people here is that as you say breastfeeding mothers' desires go largely ignored in practice, so can bottle feeding mothers as well. I live where breastfeeding is considered normal and in my circle a badge of good parenting. A friend of mine ended up with a very undernourished and ill baby due to all of the “support” she received in the hospital that women will always make enough and that formula is a lesser choice. Despite my best efforts and all the support in the world, my own baby became dangerously dehydrated and needed formula supplimentation. I ended up needing to phone the nestle company with formula questions because in my feeling like a total failure state of mind a lecture may have sent me over the edge. I realise this was just good business but the woman on the phone was the first person who didn't take a nasty tone with me about formula use. I can't imagine how badly I might have screwed up formula feeding if I was a teen mom or a single mother without the time and support to reach out. If “falling through the cracks” situations like these can occur in a place like Vancouver, Canada where breastfeeding support is wonderful and literally everywhere, I worry about what will happen when the pendulum swings the other way, like in New York where as you say breastfeeding support has been sadly inadiquate.
    I believe what the FFF is saying when she uses the words “begging for formula,” she isn't making a jab at some hypothetical psychopath nurse who wants to starve babies and upset mothers. The concern is that we haven't heard that the hospital has increased nursing resources for the amount of time this might take up. I can't imagine an overworked, underpaid nurse is going to appreciate having to deal with going back and forth for a cluster formula feeding infant and then having to take the time to chat with the mother about it repeatedly. For anyone who has been in the hospital, when you ring the bell for the nurse they can't always come running. If you have a hungry baby, seconds feel like hours right? Sometimes in the effort to correct a terrible wrong, people tend to go so far the other way they forget about the real need for a happy middle ground. If I was a sexual abuse victim maybe I don't want to constantly have to explain that to people as they come in to help me feed. Or if I was a low income New York mom who would have to go right back to work (in a non pumping friendly workplace) after my baby was born and already feeling terribly guilty about that, someone “educating” me about breastfeeding being better than formula again and again would be the cruelest thing wouldn't it?

  123. I have an extensive response on my blog: thelactationroom.net. But in short, I think that the ultimate answer will be to have milk banks for mother who can't who who choose not to breastfeed. Unfortunately I don't think this will be seen in my lifetime.

  124. I loved meeting you this weekend and getting to know you just a bit. I think your fresh perspective is an essential one in this ongoing discussion–really look forward to hearing more. (And you rocked the community keynote at Blogher!) -Liz

  125. Fearless formula feeder, I have worked in a fertility clinic, and, actually, fertility clinics do discuss the risks of fertility treatment and of infertility with families. No, they don’t berate women for not having their babies earlier, because no one can turn back the hands of time. Most women don't chose to be infertile. Most times it's not anyone's fault, and most times it's not because these families made bad choices. Yet–and I stress–there are still some health consequences of infertility and of its treatment that are unavoidable and even painful to consider. So the clinics do provide information which could seem hurtful or scary. Providing information on which a mother can make an informed decision is actually empowering and it’s also good practice. Yes, it can be done badly and insensitively, but that’s not a good reason to advocate for keeping silent.

  126. I think it's good and fair to provide all the information about risks and everyone I know who has had fertility treatment felt respected in their choice, I think. My impression is that FF raised the comparison because there is a contrast with BF advocacy, in that lactivists often berate women who did not make the “ideal” choice for the health and future well-being of their children by saying they should have made all the sacrifices necessary to BF. This probably wouldn't fly in a fertility clinic and you wouldn't have a public health program lecturing people to be sure to reproduce before the age of 30 so that they didn't burden the health care system with their more high-risk pregnancies and sicker children. FWIW there are some societies where married women who go to the ob-gyn for a checkup and have not reproduced by age, gasp, 28, get a lecture on not putting it off. American women wouldn't stand for that, and rightly.

  127. I understand that no one wants to be told what to do and how to do it especially when it is coming from the government, remove the face of the messenger and hear the message. As a mom who wanted to breastfeed badly but didn't receive the support when it became challenging, wishes I could have provided my daughter with the best which would have been my breast milk. I am grateful that I had an option available which was formula, but at the end of the day I didn't really know what I was giving my child in a can that was sitting on a shelve processed in a lab. Challenges arrive throughout motherhood and mothers have many choices to make for their children our city officials are just trying to help us give our children the best if possible. No one is taking away your right to choose .

  128. I think the use of the term “begging” came because the original initiative FAQ said that if a mom requested formula she'd receive education and then only if she “insists” will she receive one bottle of formula.

  129. NYCHealthDept, I realize this is a stock response that you've been posting on numerous blogs, but I take MAJOR umbrage at the fact that you imply that my article “erroneously dismisses the positive health impact of breast feeding…” I think I was pretty clear when I stated that this was NOT an issue of whether breastfeeding was a better choice than formula. However, if we are going to “go there”, then I would love to have a conversation with you about the body of breastfeeding research. I have no doubt that breastfeeding confers benefits. But it is a far more complex issue than you are making it out to be. Breastfeeding research is inherently flawed by the fact that we can only use observational studies. Thus, correlation and causation are often confused. I'm sure you are aware of this, being a public health official.

    That said, I have learned in the past 4 years of my work in this field that it is futile to argue the finer points of the infant feeding wars with those that are entirely convinced that formula feeding is a public health threat. And as I stated before, this was not the point of my post. You say that your goal is to “support a mother in whatever decision she makes when it comes to nursing her baby” and then in the next breath, you state “his initiative specifically is designed to support a mother who decides that she wants to breast-feed”. Exactly. What about the woman who doesn't want to breastfeed, or the woman who thinks she wants to, and then realizes she can't/doesn't want to? I am all for an initiative that “ask(s) participating hospital staff to respect her and refrain from automatically supplementing her baby with formula”, but why can't that be done by focusing on the staff and their protocols, rather than on the mothers themselves? Your paternalistic description in this comment about the benefits of breastfeeding highlights the problem with your organization: you are working under the assumption that we do not know of these benefits. If you can't bother to listen to the voices that populate this blog – the voices of highly educated women who probably know how to dissect a published study as well (or better) than most working MDs – how can I trust that you've listened to any real mothers regarding their experiences in hospitals, or to their suggestions of what would have helped them to breastfeed (or formula feed) successfully?

    Talking to the breastfeeding advocacy groups is not the same thing as talking to the moms living these experiences. Go into a maternity ward for a few week and listen with open ears, and an open mind, to the new moms. Listen to what they say about their goals and expectations for breastfeeding; to the ACTUAL barriers they are facing. Then come back here and have a real conversation with me about your bottom line.

    Bottom line: Your initiative uses specific rhetoric that makes it clear that formula is an unhealthy and “bad” choice. It focuses completely on misguided interpretations of what will “help” women to breastfeed, and ignores the needs of women who do not want to breastfeed. If you believe formula feeding is a health threat, then these motives seem altruistic. But that doesn't take away the fact that you are influencing the bodily experiences of women, and taking advantage of them during a particularly impressionable state. Considering the research on how formula advertising impacts women – you know, the same research you've used to back up this initiative – I expect that you know just how “fragile” and “open to suggestion” new mothers are. Even if you're doing it for the common good rather than financial reasons, it doesn't change the fact that you are using the same tactics as the formula companies.

  130. I think you hit nail on the head. It used to be that breastfeeding was not supported and respected– definitely a wrong that needed to be righted. But now people have gone too far in the other direction, doing the same thing to formula feeders.

    Why is it so hard to grasp that how an infant is fed is a personal/ medical decision for the mother to make? And that she is capable of weighing the pros and cons of each option along with her family's situation?

    I know infant feeding isn't always an easy choice, but there will be plenty of tough calls for the parents to make in the next 18 years. If they can't be trusted to pick a feeding method, how will they ever get through the rest of parenthood? Or will there be heavy-handed campaigns to “educate” them on the “correct” approach all along the way?

  131. Rearing children isn't a one- size- fits- all journey. Nor is it closed to interpretation. It's really unnerving to see it treated as such.

  132. “At the end of the day I didn't really know what I was giving my child in a can that was sitting on a shelve processed in a lab.” Sure, I can understand that feeling, but the stuff processed in a lab under excellent medical research made my child stop howling after every feed because of allergies. I didn't know what was in my breastmilk that put him in pain, either. We're all making the best choices we can. The NYC initiative would make me feel better about respecting these choices if it didn't start off with heavy-handed and exaggerated lists of why formula leads to greater public health risks, and if the protocol for how to handle formula didn't focus only on BFing mothers with a throwaway line about “respecting choice” but basically staying silent on formula provided for those mothers who may want to formula feed. It's not promising to have a message right out of a bullying LLL form book with the merest lip service to women who may be foolish enough to “insist” on FFing. Most women who BF are conflicted about it at some level – the extended BFers among my friends frankly say they got to a point where they hated it – but if someone chooses to supplement at night so they can get some sleep or chooses to quit after a day or two, this initiative suggests their choice is not one that can be respected because it's clearly formula-pushing that's responsible for it. I find that paternalistic.

  133. Pingback: The Literal Nanny State -- Breastfeeding And Public Health Officials

  134. I had my child after the bulk of this debate went on and physically was not able to breastfeed. I am intent on getting involved to get rid of this ridiculous legislation — do you know of any movements that are ongoing for this?? The line that really rings true with me and is puzzling to no end is this part of the blog: I keep hoping that women’s rights organizations will rise up, speak up, and stop this insanity. But all I hear is silence.

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