FFF Friday: I still feel a sense of shame…but I’m strong enough now to challenge it.”

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

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

You may recognize elements of Fay’s story – she shared her experiences as part of the Baby Friendly informal poll earlier in the week. There’s a rawness here that might be painful to read, but it’s so incredibly brave of Fay to share her feelings, even when she hasn’t fully processed them. I think that for those in the thick of infant feeding hell, hearing triumphant tales from those who have risen from the ash can inspire hope; but just as importantly, the stories of those with one foot still caught in the postnatal version of Hades can offer solace, and the reassurance that they are not alone. I know that when I was going through my own struggle, reading something so powerful and brutal would have given me the gift of camaraderie, and the permission to feel whatever I was feeling. That’s an integral part of the healing process, too.

Also- I have to get political for a second here, and say that Fay’s story reiterates why posting warnings on formula cans is a damaging, ridiculous, and dangerous idea – and there’s a movement happening, right now, to make that idea a reality in Australia and New Zealand. Our friends down under at Bottle Babies are working hard to give voice to women who oppose this movement, and you can help them by taking a survey found here. As Fay says, “I was so, so scared of the formula tins – because they’re painted out to be so utterly utterly dangerous.” But what is far more dangerous is what this unfounded and ridiculous fear did to Fay’s mental health. We cannot allow this to happen to more women, over “facts” based on observational studies and rife with caveats. 

Happy Friday, fearless ones,

The FFF

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Fay’s Story

When I deal with (ok, so it’s normally more of a verbal fight if we’re honest) militant pro-breastfeeding women, it always seems that they have some kind of mental ranking of “acceptable” reasons to bottle-feed. I tend to find that quite quickly, when they hear my story, they start to backpedal and slot me into one of those reasons. That doesn’t comfort me – I don’t need the approval of women who get their own sense of validation by belittling other women to make themselves look good – but I mention it because it continues to make me raise an eyebrow, and gives me a wry sense of amusement.

Although I intended to give breastfeeding a good go – I never got into the full-blown adulation of breastmilk as some kind of wonderful force of amazement that could cure all ills. I sat with a degree of scepticism through the breastfeeding part of my ante-natal class as they proclaimed it as guaranteeing immunity from eczema and asthma (my breastfed younger brother had the worst case of childhood eczema his consultant had ever seen) and told us how we wouldn’t die from ovarian cancer if we breastfed (my grandmother, having breastfed five children, died from a tumour there the size of a watermelon). When they got out the knitted breasts and they’d used the remains of whatever wool they had to hand – and mine was blue – I couldn’t really keep a straight face… then they didn’t have sufficient baby-sized dolls to practice good positioning – so I got this tiny thing – cue the jokes about premature babies, and the oh-so-helpful comments about “well you can’t really practice positioning on something that sized as babies aren’t that small”… I shall return to that point later.

Anyway – I planned to breastfeed because, well – they’re easily portable, not something I’m likely to forget when sleep deprived and trying to organise getting ready to go out for the day (even in my most un-caffienated state ever I’ve not managed to forget my boobs yet), and I didn’t fancy the faff of making up bottles at 4am. Add in the fact that the guidance seemed to have been set to make formula feeding as utterly inconvenient as possible – and it wasn’t so much a reverence for breast being best – but breast being easiest that was pulling me in. I thought I’d have a healthy attitude to it, and be able to roll with whatever fate handed me… I was wrong.

Week 33 of my pregnancy, Easter Sunday to be exact, and I’m sat there happily tucking into an excessively large chocolate Easter egg from hubby – and I start to get cramping pains in my stomach. I dismiss it, in a “woo hoo I finally have Braxton Hicks” kind of way and continue chomping (hey – it was nice chocolate – these things MUST be done!). Then I realise these pains are coming every five minutes, dither for a bit, and we go into the hospital – assuming I’ll be checked out, monitored for a few hours and then we’ll be on our way home.

I didn’t leave that hospital for a good couple of weeks.

To cut a long epic saga short – my waters had begun to leak, I was kept in to get the steroid injections to mature the baby’s lungs and, after a very traumatic, badly handled birth on the part of the hospital which isn’t really relevant here but included such noteable highlights as me being denied pain relief for 3 1/2 hours – but offered aromatherapy – which didn’t go down very well, and me doing almost all of my dilating on two paracetamol (which I think carries me bonus “mummy points” for being well-hard)… my daughter arrived at 33 weeks gestation, as a 4lb tiny little blue thing.

We were set up to fail from the start.

No skin-to-skin, no warm fuzzy fresh baby time – I didn’t even get to see her as she was rushed past me to NNICU. When they’d finished repairing the scene of devastation that was formerly my womanly bits, I was wheeled into the neo-natal unit, still completely numb from the waist down – and they pointed at her incubator… then kicked me off the unit and up to the ward for the night. No chance of bonding, no chance of even mentally processing that this was my child.

I was dumped on a darkened maternity ward and the Government leaflet on breastfeeding slung at me. When I pointed out that, since my baby was currently in an incubator, wired up to god-knows-what, and nowhere near me, that this might NOT be the opportune moment to be giving me this leaflet – the verbal barrage started and the leaflet, accompanied by the nurse, flounced out of the room. I just lay there – not quite able to deal with everything that had gone on – and kind of wondering what exact use the breastfeeding leaflet WAS to me, that night at 1am, with my baby nowhere near me, and no one looking much interested in helping me start to see if I could express some colostrum. Surely they didn’t expect my boobs to reach down the corridor, take a lift and get through security onto the ICU?!

The night, the worst night of my entire life, passed eventually and I was wheeled down onto the NICU and allowed to hold this tiny tiny creature. Remember the comment about the tiny doll at ante-natal… where it was dismissed as “babies don’t come in that size”… well mine apparently did. No one had prepared me for how to handle something so small – let alone manouver her onto my very large at the best of time breasts. Someone on the unit took pity on me and helped me try to express some colostrum – but then I was put into the first impossible position… “We’re going to put a feeding tube down your baby’s nose, your milk hasn’t come in yet so we’re going to give her formula… which brand?” Utterly numb from it all – I just let them choose and then had the horrible experience of watching them fit what would be the first of many NG tubes. They sorted me out with a breastpump nozzle and a steriliser – did a little bit of token helping me to try to get her latched on – but it was very much a “throw breast in vague direction of baby and hope it sticks” type of help. When you’re dealing with a tiny baby, with wires everywhere and this huge long tube dangling out of her nose – everything is about a hundred times harder to handle anyway… she couldn’t latch – she’d lick at the nipple like a kitten lapping milk – but that was it.

Time passed, I pumped and my milk came in (but weak in supply) – I fed what I could pump down her nasal tube, topped up with formula, but despite trying and trying and trying – she couldn’t latch, or when she could, she couldn’t maintain the latch – she was too small, too weak, too sleepy to do so. Add in the incessant interruptions of hospital life when you’re lying there half-naked fumbling away trying to get a large breast into a tiny baby, and the fact that ALL our breastfeeding lessons had been totally ignorant of the possibility of premature babies and how different it is handling them – and we were getting nowhere.

Because of various other circumstances surrounding the birth, and the fact that I was having to live on the maternity ward from hell, with no option to leave the hospital – and my mental health was starting to suffer. Trying to get her to latch every feed with no luck, having to do all her NG tube feeds, and pumping every two hours was absolutely destroying me. The tipping point came one night when I was talking to one of the staff whom I’d got very close to (she’d had a premature baby herself) and mentioned I had no idea how long we were going to be prisoners on the ward for, and she mentioned it was going to be an additional 2-3 weeks MINIMUM for us to be allowed to leave breastfeeding. Since we STILL had no sign of any progress with her being able to latch on, I asked for a bottle to try to feed her some of the expressed milk that was going down her feed tube… and she took, and I can still remember the figure now, 12 mls of the 34 mls she was taking at that point in time – and I cried. I cried with relief that I’d seen her ACTUALLY feed, by mouth, like a normal baby. And I cried because it was the first sign I’d had of any tangible progress, and because I’d been able to hold her close and provide that for her, rather than lie her down and hold a tube up in the air after a few fumbled breastfeeding attempts each feed.

Yes, I sold her out in that I took the “easy” route. I regret deeply that her mum wasn’t strong enough to stick out trying to get her to latch but I figured at least if we went home with me expressing, I’d possibly keep my options open and be able to get her to latch on when she got nearer being full-term. The amount she took by bottle rose steadily each feed and within a few days they were talking about removing her tube and sending us home. By this point I was taking domperidone and sniffing aromatherapy oils to try to increase my supply – but I was doing it, and she was feeding, actually feeding, and they took the tube out, and she did it all on her own!

So they let us go home, and I pumped, and I pumped, and I pumped… and dad did all the feeds, cuddles and being a parent thing… and I pumped, and I pumped… and we didn’t go out because I always needed to get home and pump… and I spent hour and hour and hour cleaning and sterilising breastpump parts.

I tried to get her to latch – with no luck. I tried nipple shields – no luck. All anyone gave me in terms of advice was “more skin-to-skin”… so I added that in among the interminable pumping. By now, my breastpump motor was starting to fail, as was my supply – but I kept going. In addition to it feeling like the ONE bit of my “mummy” hopes and dreams that HADN’T gone to hell because of her prematurity – the pro-breastfeeding camp, the propaganda about formula being akin to cyanide, the fear of how on earth did I make up feeds correctly (because they don’t give you that information easily any more for fear that it makes formula feeding “normal”) kept me going.

And I hit a wall – as she hit full-term, and STILL couldn’t latch properly – my supply was gone, my pump was really almost dead and my freezer stash had run out. We bought formula, and I sobbed so hard when we fed her it. I felt as though I’d sold her out by not sticking out the hospital – but I know if I had done, the toll it was taking on my mental health was so bad I would have attempted suicide soon, and I felt as though I’d failed her so badly as a mother – that my body had failed her and she’d been born too soon, and that my willpower had failed her in that she wasn’t breastfed. And I was so, so scared of the formula tins – because they’re painted out to be so utterly utterly dangerous. I remember once wailing to my husband that “I’m feeding her POISON!!!”

But I didn’t have a choice – circumstances had made the choice for me – she HAD to be fed.

And this 4lb little girl, sleepy and jaundiced who never woke and just lay in her cot… she’s thriving. She’s a ball of funny little baby who’s doubled her weight and is about to hit appearing on the growth charts and is catching up with her full-term peers fast. She’s not hitting milestones on schedule for her actual age (which she wouldn’t be expected to) – but she IS ahead of them for her age adjusted for prematurity.

Her mum’s doing somewhat less well, has PTSD from all we went through at the hospital in the NNICU, still feels guilt over it all, but is dealing with that – but does take pleasure every day in the biggest grins from the evil genius in training (she’s got the maniacal giggle down already) that is her little girl. I still feel a sense of shame if I have to bottle feed her in public, I still feel that I need to justify how she’s fed. I feel sadness and anger at how the hospital failed us in terms of their provision for preemie babies – but I’m strong enough now to challenge it.

And it isn’t the horrific faff and hazard that they made it out to be.

It’s not 100% positive, it’s not a choice I’m fully come to terms with – but there you go – my story.

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Doesn’t matter if you’re still in the midst of your story, or ten years past it – telling it is important. If not to you, then to some random other parent on the internet. E-mail me at formulafeeders@gmail.com if you’re ready to share.

Introducing the Family-Friendly Hospital Initiative

My first experience with a baby friendly hospital was far from pleasant….because no one had really showed me how to attach, just pushed and shoved my breast, my nipples became blistered and bloody…As day 3 approached it was clear my son was having a few issues.  He was becoming jaundiced, he still hadn’t passed any sort of wee.  This was when the contradictory advice began.  One told me he was a lazy sucker and that I had to watch for Nutritive sucking, where his whole jaw was moving, all the dummy sucking was not getting him any milk.  Another midwife told me that was nonsense and any sucking was getting him milk.  One told me my latch was good, another told me it was rubbish.  It seemed with every shift change I got another piece of different advice.  I was more confused than I had ever been in my life and I had absolutely no idea what I was doing.  They had me constantly hooked up to the breast pump, hoping to encourage my milk in but I never got even a drop out…he had lost nearly 30% of his body weight in 3 days, they aim for 10% at the most.  I felt angry,  I had told them my baby was starving.  Any time I had asked for formula I was told it would affect my milk supply and refused…I had to sign a form allowing him to have the bottle.  He gulped it down and went straight to sleep.  The first time really since he had been born.  The next morning when with a new midwife when I asked for another formula top up I was given a spiel on how ridiculous it was to have given it too him in the first place and I would destroy any chance of ever having any milk.  When my husband asked which formula they recommended if we decided to go that way because he could see how thoroughly overwhelmed I was he was told they don’t recommend formula.  Those two bottles allowed his weight to go up enough however to allow us home after another night so we finally got out of there.  I left exhausted, nipples absolutely shredded, confused, overwhelmed and violated….Baby friendly maybe, mother friendly most definitely not. - Courtney

“My local hospital is “baby-friendly”…  My own opinion of this implementation is that it was distinctly “mother unfriendly” - to the point I’m still traumatized by what went on now and regularly cry myself to sleep over it all. My daughter came prematurely, was sent to NICU, while I was sent to the post-natal ward… I had a leaflet on breastfeeding slung at me, and when I pointed out it was a tad insensitive- I had a premature baby in an incubator not even on the same floor in the hospital as me, and I couldn’t do anything since she wasn’t even WITH me (none of the staff had broached expressing or pumping at this point) – I got snarled at that “breastfeeding is really important you know” and the nurse flounced off…After about a week and a half, when I was truly at the point of crumbling, when we’d made no progress at all with breastfeeding and latching, one wonderful nurse put her neck on the line and broached the taboo (bottles, formula and teats were very much the elephant in the room everyone was too scared to mention) and told me that basically I would be looking at extending our time in hospital by another 2-3 weeks in order to be able to go home breastfeeding… I asked to try her with some of this expressed milk in a bottle to see what she would take… From there she really turned the corner. However because of being “baby friendly” – the bottles, teats and formula were hidden away behind the nurses’ station (very similar to the NYC proposals) – you had to do the walk of shame, akin to being on the Weakest Link, to go and collect them… it was literally a matter of a few days from that first bottle feed to her being able to take her full feed requirements and maintain/gain weight and have her feeding tube removed – the hospital would have let me plod on in ignorance that this was possible to sacrifice my mental health on the altar of their baby friendly status quite happily. The prolonged stressful nature of our hospital stay has left me with an anxiety disorder requiring medication, sleep problems and I cry myself to sleep on many many nights over the trauma we went through – this is after counselling as well. I switched to formula feeding as my supply dwindled and my breast pump motor died in the end.” -F.T.

A colleague said something to me last week that really knocked me on my ass. She asked if I had lost my passion for this blog, and for the cause in general; she told me that FFF “wasn’t what it was” a year ago. I’ve reflected on this for the past 5 days, and I started wondering if maybe I was the Internet equivalent of an aging beauty queen, hanging out at the local cougar bar and wearing pants that were more appropriate for my 14-year-old daughter. It was a scary thought. (And a little too close to home, as I still shop in the Juniors department, on occasion.)

On further reflection though, I don’t think I’m old, or tired, or lacking passion – I’m just a little jaded. I’m jaded because I realize that blogs can only go so far; that the time has come to take FFF to the next level and begin forming concrete advocacy efforts and fighting for real, practical change that can lead to flesh-and-bones support, rather than just the virtual kind.

This advocacy will begin with an endeavor I am calling the Family Friendly Hospital Initiative (FFHI). I originally planned to call it the “Mother-Friendly” initiative since the mothers are the ones physically engaged in breastfeeding, but ultimately chose the name “Family Friendly” to reflect the fact that families are made up of not only babies and mothers, but also biological fathers, adoptive parents, gay and lesbian spouses, and siblings with their own specific needs. We need to approach all types of famiIies in a holistic manner, recognizing that the health, happiness and economic stability of the entire family is vitally important to emotional and physical health of a growing infant and to our society as a whole.

I plan to approach hospitals, local media, and government officials to encourage adoption of the FFHI, a program that can work in conjunction with the BFHI Ten Steps, taking the best parts of that program and clarifying the aspects that could potentially infringe on a woman’s right to choose how to use her body. I am going to fight, tooth and nail, for hospitals to start offering bottle-feeding classes, or if this isn’t a possibility, perhaps giving access to a hotline to connect new moms with trained peer advisers who can walk them through safe formula preparation, outline the best pumping and milk storage practices, offer suggestions to common formula concerns and complaints, and hopefully provide peer support groups which can meet, much like breastfeeding support groups, but for formula-feeding, pumping, tube feeding and combo-feeding mothers.

There is no reason that supporting and promoting breastfeeding has to mean punishing the women who either choose to formula feed, or end up doing so for any number of valid reasons. The Family Friendly Hospital Initiative will promote breastfeeding as the healthiest choice, but will frame it as a truly informed choice, giving concrete, real-world statistics in contexts that any parent can understand, not just the ones with a degree in epidemiology. It will adhere to practices shown to improve breastfeeding rates, but make the ultimate goal a healthy, fed baby and a confident, emotionally healthy mother and/or father. The FFHI will reach out to postpartum mental health professionals and organizations and attempt to make maternal postpartum health a significant priority. It will encourage researchers to engage in studies which will learn from women who are not breastfeeding, rather than dismissing them; studies which will make bottle-feeding (whether it be formula, donated milk, or expressed maternal milk) safer; studies which will help us determine how our societal evolution has affected breastfeeding, and how to merge a woman’s innate desire to feed her child naturally with the reality of an incredibly unnatural world.

Take the good….

“…Every nurse who came to check on us was extremely respectful. They all asked before touching me and gave great advice about how to get him latched and how to take care of myself while breast feeding. Once we were discharged, we received follow up care from community health nurses. They check on everyone by phone, but came to visit us in home after hearing about the number of times my son had been up to feed. They weighed him and provided a lot of encouragement. When the jaundice was getting worse, not better, it was a community health nurse who was also a lactation consultant who said, ‘How do you feel about formula supplementation?’” - Lisa

“Baby 3 was born in a baby friendly hospital and was my best experience.  The LC came in just to see how I was going to feed and offered support with breastfeeding or formula feeding.  She just wanted to see mommy and baby happy.  She even checked on me knowing full well my baby was receiving a bottle just to make sure she wasn’t having any issues with the formula.  I breastfeed baby girl enough for the colostrum like son 2- but I didn’t feel judged at the hospital at all- in fact I felt fully supported.”   -Betsy 

 

When I asked my Facebook followers to share their experiences of “baby friendly” hospitals, I was shocked – and not for the reasons you might think. I was expecting tales of shaming, mistreatment, and inferior assistance with the actual mechanics of breastfeeding. But instead, the majority of the stories posted on my Facebook wall were positive. “I went in planning to use formula. I was so nervous,” says Amy. “Every single person was supportive, did not say one single word about it, and several actually expressed relief for me! …They didn’t have much advice on stopping my milk but they tried. My pediatrician seemed thrilled too. I went in ready to defend and they were all SO fantastic.” Natalie reports that the “hospital staff were all very kind. Every time they asked if I was going to try breastfeeding, I would start with my big long explanation, and they’d stop me right away and say ‘it’s your choice, you don’t need to explain’”. A few readers had given birth in both baby-friendly establishments and hospitals that hadn’t adopted the initiative, and they gave much higher marks to the baby-friendly ones. Allowing babies to room in, experience skin-to-skin immediately after birth, and having more lactation consultants or breastfeeding-educated nurses on staff are changes most new mothers would applaud. Obviously, there are elements to the baby-friendly program that should be commended and implemented worldwide.

…But Leave the Bad

I delivered at a baby-friendly hospital. I had intended on giving breastfeeding a try but was not sure I wanted to do it long term…When I delivered, a nurse helped me initiate breastfeeding…He was not latching well, which I assumed the LC would have told me. I now found out that it is against their policy to use prosthetics (shield), which would most likely have saved our nursing relationship and helped my sleepy baby latch… They checked his bili levels and they were sky high. I told the night nurse she could feed him formula and I was fine with that. She fed him 25ml through a syringe. The next morning I was told the machine used to check the levels was malfunctioning and he was actually fine. The LC berated me for allowing my baby formula. After our release he became too tired to latch and would scream. The pediatrician told me I should supplement. I gave him a bottle, and he refused to nurse. By the next day, he had gained 4oz and changed color. I stopped after that for my own sanity and recovery. My experience wasn’t horrible at the hospital, but when I was looked down upon for allowing him formula I felt as though it wasn’t so much about me making a decision I thought was best, but them not being able to check off that ‘exclusively BF’ checkbox.” -Sara

“Because of my problems with (my first child) I was leaning towards formula but still wanted to attempt the breast or at least get the colostrom benefits.  When the lactation consultant came in, she was rude.  So rude.  I explained my troubles with my first son- where she informed me that the problems I experienced were impossible, she isn’t there to convince me to breastfeed, and I am sabotaging my efforts with son 2.  By the time she left the room, I was crying. Literally crying.  I told the nurse to get my son a bottle of formula so I would never need to see that woman again.  Turns out son 2 tongue sat back in his mouth a little too far and needed a preemie bottle nipple.  LC might have caught that and offered me a shield or something if she hadn’t been there to just berate the hell out of me. - Betsy 

Despite the numerous positive experiences voiced in this small sample, adopting procedures which focus on an end goal (having most babies exclusively breastfed upon discharge from the hospital) can lead some care providers to fall prey to human tendencies of fear, selfishness, and bias. It is evident that so much depends on the individual care providers and administrators of each hospital; the Baby Friendly Hospital Initiative (BFHI) is based on the organization’s Ten Steps to Successful Breastfeeding, which are meant to “promote, protect, and support breastfeeding”. Yet, the program is often simultaneously promoted as a way to improve maternity care in the United States, to bring hospital birthing to a more personalized, less sterile level. And while these two goals might seem to work in tandem, there’s too much left to interpretation in the Ten Steps to ensure that they really do. In fact, in some cases, it seems that the emphasis on exclusive breastfeeding for the good of the babies is subjugating the needs, autonomy, responsibility, rights and desires of the mothers.

Still, I do believe that things must change in our hospital system so that women will be supported in their efforts to breastfeed. New mothers shouldn’t be sabotaged or bullied, no matter if the substance in question is formula or breastmilk. And the early days of breastfeeding are incredibly vital – both physically and emotionally. I simply want to make sure that women are supported in both the former and the latter respects.

Engage the professionals

“My son was born in a “baby-friendly” hospital. In theory, it’s all very good and helpful, but I feel the nurses need to be given a reminder about personal boundaries and coherent advice. I was pretty upset that they wouldn’t let my husband hold him after the birth and that they manhandled my breasts (without asking first) to try to painfully extract some colostrum (which I didn’t have at all) because my son apparently needed to have some *right now*. I was exhausted and just wanted to be left alone. I wanted my husband to take the baby so I could sleep. There was a lot of manhandling and nipple-pinching during the next feeding attempts, which was very painful and disturbing…Also, my son slept for most of his 48-hours hospital stay. I went to the nurses station to ask them if I should wake him to feed him and I was told “no”, but when I was discharged, a nurse scolded me for not attempting to nurse every 3 hours. I felt confused and misdirected. I was happy to leave!”  -Roxane

I believe that most people go into the medical field – a care profession – to help others. We cannot ask nurses and physicians – professionals who carry the credo do no harm close to their hearts – to subjugate the needs of one patient for that of another. We should be asking these professionals to work with us to improve infant feeding practices, rather than demanding they behave in certain ways (ways that may be in direct conflict to their instincts as caregivers) in order to meet government goals. Therefore, I hope that medical professionals – especially maternity care specialists – will join me in urging the adoption of this initiative. Perhaps it will also be more palatable to hospitals who have shied away from becoming baby-friendly; if the goal is to end practices which sabotage breastfeeding, it shouldn’t matter whether we do it via WHO/UNICEF-endorsed methods or our own modified American version.

As I’ve been researching the BFHI, another realization I’ve had is that despite all intentions, women are still being given atrocious advice in baby-friendly hospitals- advice that would make most experienced LC’s cringe. A friend recently gave birth at a Kaiser hospital here in California, one that prides itself on being Baby Friendly. She told me the most curious tale of how, when her newborn didn’t latch right away (and I’m talking like 3 minutes into the first skin-to-skin, right after the cord had been cut), a nurse dribbled formula all over my friend’s chest, apparently to encourage the baby to latch. Considering step 6 of the BFHI is “Give newborn infants no food or drink other than breastmilk, unless medically indicated” and my friend’s baby was born perfectly healthy, I have no flipping idea why this would have been done.

I suspect that when the focus is solely on having women leave the hospital breastfeeding exclusively, rather than on encouraging long-lasting, healthy, happy breastfeeding dyads, bizarre and contradictory actions will continue to occur. By talking with healthcare professionals rather than treating them as the enemy, or assuming they are all pawns for the formula industry, we can hopefully come up with better protocols that lead to better outcomes overall.

Encourage individualized patient care

“My baby latched perfectly and all was great. Except that I hated it. No matter what the hospital does, I believe women will quit breastfeeding for all kinds of reasons. I hate calling it “succeeding” at breastfeeding because I think success is determined by a happy healthy baby and mom, which isn’t always breastfeeding.” - Erin

“I have 2 sons, now 2 and 4.  I also have PCOS and hypoplastic breasts.  I tried to breastfeed my first, didn’t work.  Didn’t even try with the second (with the blessing of the same LC who was at the same hospital and remembered me!  Took one look at me and said, “nope, don’t bother.”).  By the time I had my 2nd child, the hospital had become “breast friendly”, in their words.  So they were not giving away the formula bags and samples any longer.  Nurses told me that they actually had to THROW THEM AWAY.  Since I had been expecting these items, I was shocked to hear this.  When the director of nursing stopped by to take a little survey on my stay, I really let her have it.  “But we’re BREAST FRIENDLY” she kept repeating.  My response?  ’Well guess what honey, my breasts aren’t very friendly, and they don’t make milk’”.-Rebecca

I actually believe that most of the 10 Steps outlined on the BFHI website are perfect for encouraging breastfeeding, and seem to reflect the research that has been published on this issue. But I think that there is a fundamental flaw in the program: it does not give sufficient attention to the needs of bottle-feeding parents. Mothers have different birth experiences, different socioeconomic backgrounds, different ethnicities, different emotional makeups, different physical impediments. Mothers are different. Treating all American mothers as one homogeneous, uniformly-lactating group is a recipe for disaster. There’s a movement afoot to change the face of maternity care in this country – homebirths, or hospital births assisted by doulas or performed by midwives are becoming more popular. We seem to be having two parallel conversations – one that says “treat me like an individual, not as a medical case to be managed” when it comes to birth, and one that begs for overly-monitored, medicalized, one-size-fits-all treatment when it comes to breastfeeding.

There is no reason we can’t follow most of the BFHI steps, and still provide resources, emotionally neutral education, and equal support for those who opt to combo feed or formula feed.

Education, Not Indoctrination

“No discussion of challenges in our BFing class, just all the joys and benefits. Frankly, I think it’s much better to discuss potential problems even if they affect only 10% or so of mother-baby pairs. Knowledge is power, and you aren’t blindsided by pressure or bullying or confusion either way in the days immediately after birth if you know what to expect. I seriously don’t understand why anyone would think it wasn’t important to discuss potential problems. It would be so much better for getting people to know when to get help.” -Sumita

“In fairness breast feeding wasn’t really covered either – it was more here are the benefits this is why you should – and this is briefly how it’s done- we will show you when you have your baby. Formula wasn’t even mentioned at all. - Kate 

I took a breast feeding class at the baby friendly hospital I have birth in. They never talked about any problems that could come up. Only the benefits and good things about breast feeding. I spoke to a nurse while I was in the hospital and asked her how come I wasn’t told about flat nipples, latching issues and such and she said that they don’t discuss negative things in the breast feeding class so that women aren’t discouraged. In my case it would have been very helpful to know about issues like that because it would have avoided me getting depressed about not being able to breast feed my premature baby.” -Rosella

“We are set up for failure and every real life mom I know knows it. SO many women I talk to NOW commiserate with how hard it can be, but all the literature, all the websites give such an opposite impression. Like, why WOULDN’T you breastfeed if its beautiful, bonding and almost everyone can do it? If everything they said was true, everyone WOULD breastfeed. But its not true for everyone.Rachel 

The number of mistakes I made formula feeding my first born because of the lack of info frightens the hell out of me to this day. I called a nurse hotline once to ask some questions and got a lecture about how I should try to re-induce lactation.” - Mina 

Regardless of what happens in the 48 hours after delivery, the education parents are receiving about infant feeding is downright embarrassing. Classes drill the importance of breastfeeding into our heads without giving us much practical information on how to actually nurse; this is somewhat understandable as it’s the kind of thing you can’t really learn without doing. However, a brief acknowledgment of some of the more common complications would be an easy thing to add to prenatal curricula - latching issues, flat or inverted nipples, tongue ties, commonly used drugs that may be contraindicated, health conditions such as diabetes or PCOS which could potentially complicate breastfeeding – and doing so would prevent many women from feeling like failures when breastfeeding doesn’t come easily. Considering the emphasis on avoiding nipple confusion and establishing milk supply in the first few weeks which permeates the canon of breastfeeding advocacy literature, it seems logical that we should do whatever we can to ensure that women are not blindsided by these issues – forewarned, they could come up with a solid plan with a lactation professional which could prevent actions made in moments of confusion and panic.

Additionally, the lack of education about formula feeding is a travesty. I have written about this many times before, but I will reiterate: if only 36% of American mothers are breastfeeding exclusively at 3 months, that means a majority of babies are being fed formula. It is IMPERATIVE that they are properly supported in doing so. Ignoring the fact that formula is a reality in the lives of many parents doesn’t just punish the parents- it affects the babies. True, formula feeding isn’t brain surgery – but it could be argued that breastfeeding is an instinctual act for humans. Formula feeding? There’s nothing instinctual about it. There is a huge margin for error. I personally suspect that many of the subtle health disparities we see in the aggregate between formula fed and breastfed babies are due to avoidable and common mistakes in formula preparation and selection. Most parents have no idea what the difference is between a “sensitive”, “hypoallergenic”, or “lactose-free” formula. They don’t know that the angle of the bottle, the flow of the nipple, and the type of formula (powdered, liquid, concentrated) could affect their baby’s digestive system. They don’t know what water to use, how often they really have to sterilize bottles, or what formula to choose. They must rely on friends and the internet for advice about something that should be – unlike breastfeeding – a regimented and meticulous process (sadly, it seems our society has this flipped. Breastfeeding is treated like brain surgery, and formula feeding is seen as something we should inherently know how to do…). Medical professionals may be used to the “formula feeding model” for things like weight gain and feeding schedules, but even this is more true of the “old guard” (those who have been practicing for a long while, before breastfeeding’s resurgence) and these same folks might not be aware that there’s been research and new thought on the bottle-feeding front since they got out of med school in 1963.

I propose that breastfeeding education be altered to reflect some of the realities of breastfeeding – common challenges, medications, diet, and pumping – the same things discussed on KellyMom, Mothering.com, and The Bump. I also want to see hospitals offering bottle-feeding classes and resources once a mother has voiced a desire to either supplement or completely formula feed.

The “Parent-Friendly” Manifesto

I am not sure what form this “initiative” will take just yet, but I am hoping that FFFs across the country will join me in advocating for positive change. It is healthy and necessary to mourn the loss of breastfeeding, or rage against the current atmosphere of shaming and belittling formula feeding moms – but we can turn that anger and grief into positive change. I know we can. Let’s work on this, together, so that no new moms have to go through what we have gone through. Let’s make it so  FFF Fridays become obsolete, because there will be so few people who feel bullied, abused, or let down by their experiences. Let’s make my friend’s comment a reality – make it so that I have lost my passion, because there will be nothing left to get fired up about.

Who’s with me?

FFF Friday: “There are other ‘right’ choices…”

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

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

This weekend, I will be announcing a new focus and goal for this blog, and for my personal advocacy efforts. Part of this new endeavor has to do with prenatal and postnatal education, and Julie’s story below illustrates why this is so important. We cannot keep setting women up for disappointment by only offering potentially detrimental half-truths. I hate that Julie feels guilty, and worries that her aversion to formula was due to selfishness on her part. With messages like  ”good mothers breastfeed!” and “all it takes is one bottle of formula to destroy your child’s health!” dangling over our heads like some sort of macabre mistletoe, it’s completely understandable that new moms become obsessed with breastfeeding “success”. I hope we can all start turning that anger and disappointment outward, but in a positive way – using our experiences to change the course of breastfeeding education and promotion for the better. But more on that later. Right now, I hope you’ll give Julie’s FFF Friday submission the attention it deserves.

Happy Friday, fearless ones,
The FFF
****
Julie’s Story
When I heard the hospital I was going to deliver at had a breastfeeding class I registered right away. I was going to breastfeed. There wasn’t another option in my mind. I had given away all the free samples of formula I had received because in the class, led by the hospital’s 2 LC’s, we were told having them in our house would be “booby traps” in the middle of the night when we were frustrated with a crying baby. I was told that only 2% of woman can’t physically breastfeed so it was very unlikely that anybody in the room would fall in that 2%. If we really wanted it to workwe could make itwork.
I delivered my daughter after 16 hours of induced labor after my water broke and I had no contractions on my own. Right to the breast she went, skin to skin, everything I was told to do in that class but something didn’t seem right, even to this first time mom.
The nurses tried to help, I called the LC and she said everything looked perfect, and as we were being discharged the pediatrician told us to come back the next morning to have her bilirubin checked because her jaundice didn’t seem to be improving. That next morning came and I felt like the worst mom in the world – her levels were so high that the doctor on call questioned why we were even released to begin with. My 4 day old baby was admitted to the pediatric floor for phototherapy.
 I was given a pamphlet telling me what detrimental affects prolonged jaundice could cause but I was still unwilling to give her formula because I kept hearing the voice of the LC. “Introducing a nipple or pacifier before our breastfeeding relationship was established could ruin any chance of successfully nursing.” The doctor hadn’t insisted on it, so I kept nursing her like clockwork and her diapers were weighed to see what kind of output she was producing – or in her case, wasn’t producing. She was sucking on empty breasts. It wasn’t until her doctor told us that she was very seriously ill and that we NEEDED to give her formula that I caved. Then, I broke down in tears because I had been starving my baby. I was so dead-set on breastfeeding – it was natural, the best nutrition, and 98% of woman can do it. (I’m a math teacher so the logical part of me should have realized that SOMEBODY had to be in that 2% but I was stubborn and thought it surely couldn’t be me).
I still didn’t give up hope that we could regain our breastfeeding relationship, so I took herbs, ate oatmeal, saw an outside LC, had her tongue tip clipped (although thinking back, I don’t really think it was necessary but I was desperate for a solution to our problem), and pumped and pumped and pumped. I never saw an increase in supply and at my best, I only pumped 1/2 an ounce from both breasts combined.
I hated feeding my daughter because it meant attempting to nursing her, giving her a partial breastmilk/partial formula bottle, then pumping. By the time I was done I had about enough time to use the restroom and then I was back at the triple feeding again. I spent more time with that pump than I did with my little girl for the first 2 months of her life.
I finally said enough is enough but I doubted that choice several times before I finally committed to 100% formula feed. To say I was sad would be a huge understatement. I was devastated and would soon after be diagnosed with postpartum depression. I would have crying spells anytime I thought about the dream I had to have that close nursing bond or when I heard about somebody else loving the cuddle time they were having while nursing. I was mourning the loss of the perfect scenario I had in my mind (and was flourished by that oh so inspirational breastfeeding class).
As my daughter’s first birthday rapidly approaches (this coming Friday, June 22nd) I am just now finding peace within myself about not breastfeeding her. By reading the other stories on this site and by realizing there are so many other facets of my daughter’s childhood to rejoice in, I can FINALLY see how important being happy and enjoying my daughter grow up really is. I don’t mourn the loss of breastfeeding anymore, but I do look back and think about how selfish I was being by wanting it to work so bad.  I was choosing to not feed my baby formula at the risk of “ruining” our breastfeeding relationship. I wish I had known that we would still have a seriously strong bond, that we would have plenty of cuddle time and that everybody would be happier if I just let it go earlier and accepted it wasn’t meant to be.
That class was a disservice to my daughter. I know the LC’s must have meant well by glorifying breastfeeding and dismissing formula feeding all together, but it put my daughter’s health in danger. Every parent wants to do the very best they can for their children and according to that class, breastfeeding was the only way to accomplish that in terms of feeding. I am so grateful this site exists so other moms can see that there are other right choices for their babies.

Guest Post: Formula feeding tips – since you’ll be hard pressed to find them elsewhere

Like a good cup of tea, some ideas need a bit longer to steep. Therefore, while I try and get my next post (one that is not merely a post, but a call to action for all FFFs) to sound somewhat coherent, I’m going to share the following guest post from Firgas Esack, who wrote me a spectacular email a few months ago. I loved what she had to say, so I asked if she could elaborate. She obliged. And I am thankful she did, because I think her essay kicks ass. 

I’ll let Firgas explain her point of view, but I do want to say that I share her outrage at the lack of quality information regarding formula feeding. I’ve tried to make up for that lack of info with my FFF Quick-and-Dirty Guide to Formula Feeding, which I’ve been sloooowwwwly building over the past year or so. It sucks eggs that you need to rely on a blogger who doesn’t have an M.D. for this type of info, but I’m working on it, y’all. (The fact that there isn’t better medical advice on formula feeding, not the M.D. – although that would be cool… Dr. Fearless…. paging Dr. Fearless….oh, lay off, a girl can dream.) 

I’ll be back either tomorrow or this weekend with a new post (at this point, I’ve built it up to such a degree that it better be really good, which of course means I need to spend more time checking it for typos) but for now, sit back, relax, and enjoy the literary stylings of Firgas Esack. Oh- and speaking of a nice cup of tea, she’s British. British people like tea. Almost as much as I like cliched metaphors.

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Formula Feeding Tips- Since You’ll Be Hard Pressed to Find Them Elsewhere

by Firgas Esack

If you googled ‘Formula Feeding’ and you came to this site I’m guessing this makes you one of the following:

Category A: Like my partner and I, you’ve chosen to formula feed your child.

Category B: for whatever reason, you didn’t set out to formula feed your child but now you have to.

Category C: you are a staunch breastfeeder and are trawling the internet for someone to pick a fight with.

Now, the internet is a pretty helpful place. Over the years I have gained many a skill – from unblocking my sink to knitting legwarmers – but  (with the exception of this site) there are criminally few sources of honest-to-goodness facts, tips and advice on formula feeding – and if you fall into Category A or B this is probably what you are currently looking for.

Ditto midwives. Whilst I was pregnant I lost count of the pamphlets I was given about breastfeeding. There were cartoon ones, for the more playful would-be-BFer. There were ones that explained mastitis in plain English. Politically correct ones with multicultural mammary representation. Ones championing local volunteers who offer to visit my house and patiently show me how to put my boob into my child’s mouth correctly.

But with FF not so much. Yes, sure – the pamphlets mention the subject. As an afterthought or an appendix. Possibly with diagrams so archaic and clinical they resemble the Biology textbook which explained baby making to me in the first place. Furthermore, if a medical practitioner ‘doesn’t support’ formula feeding are they really experts to seek advice from?

I could also get some ‘information’ on the subject of FF from one of the many Mummy chatrooms out there. But try and read more than four responses into any thread and doubtless it will be crashed by a Category C person suggesting your DD or DS will be struck down with Leukaemia, live life as the class dunce or possibly grow gills as a result of consuming formula.

Even ACTUAL FORMULA BRANDS require me to tick a box before entering their website essentially declaring myself as a second class mother before reading about their product.

As I said at the top of this post, we chose to FF. But even if we hadn’t, the choice still exists as that: a choice. Yet whilst I can find plenty of guidance on how to build a bomb, roll a joint or start a cult on the interweb, I still found myself having to call up premium rate helplines advertised on the backs of formula packs – whispering into my BlackBerry so as to somehow not let on my ineptitude to my son – in order to find answers.

So – for the benefit of Category A and B readers – here are some of my FF tips based on our experiences. I’ll just add here that I live in London, UK:

  1. People will have you believe sterilizing takes a science degree to master. Sterilizing is a doddle if you get a steam sterilizer. Don’t bother with the fluid (unless you like the smell of bleach) but we recently went traveling and found those sterilizing tablets brilliantly convenient.
  2. We had no idea what brand of formula to buy. In fact, I bought every brand in the supermarket and made a spreadsheet comparing all the nutrients. But our son liked Aptamil the best, so that’s what he drinks.  And as for the cost of FF, yes – it’s not cheap. But then neither is eating mackerel and camembert daily to ensure your breastmilk is rich in Calcium and Omega 3. Nor are Pirate parties, piano lessons or the little one’s future obsession with Ben Ten for that matter.
  3. Babies are happy to drink formula at room temperature or even cold. Obviously warming bottles is ideal but you drink cold milk so why shouldn’t they? Don’t beat yourself up if it’s 2am and you can’t get the bottle warmer to work or can’t face asking the smug waiter in a restaurant to heat one up.
  4. People zealously proclaim that BF babies have sweeter smelling poop. Personally, I’m not that into sniffing baby poop so have no great desire for it to smell of candyfloss. But if your bambino’s botty is producing something that’s a strange colour (grey, green…) it’s most likely temporary and most likely caused by him working some dirt or other through his system. Dirt most likely NOT from FF but from the big wide world he’s now exposed to.
  5. With formula it is easy to get your little one onto a feeding schedule that resembles yours: breakfast, lunch, supper – and a couple of snacks. You’re unlikely to overfeed if you do this and it’s a bit more sociable for all concerned than cluster breast feeds. Category C people make a lot of noise about overfeeding: as a parent you’ll be controlling your child’s portion size for many years to come so it’s no harder with a bottle than with a bowl of ice cream. Trust your instincts.
  6. Many formula companies offer a version marketed for ‘hungrier babies’. This is a little confusing (surely all babies are hungry?) but essentially fills them up so that you can hold off weaning for longer. We found a little bit of mix and match works well: hungry food at night and regular during the day.
  7. There are various schools of thought about giving water as well as formula. Unless you live somewhere really hot (i.e. not London!) you only need an ounce or so of water per day, tops. We offered our son boiled, cooled water in a tippee cup from around 12 weeks – he controlled how much he wanted and he learned to use the cup. Interestingly on our recent traveling adventure we discovered that formula companies in warmer climates make powdered fennel tea to rehydrate FF babies – it is meant to be beneficial and it’s a nice idea to have a child that prefers herbal tea to Sunny Delight later in life.
  8. Bottles come in all sorts of shapes and many people think it is the bee’s knees to have a bottle that resembles a breast. In our experience, the cheapy, straight up and down ones you get from the chemist are easier for the baby to drink from without trapping air bubbles and therefore less likely to cause hiccups or spit up.
  9. Finally, if anyone genuinely thinks that FF reduces their ability to bond with their baby then I’d question what the heck they are doing with their little one the rest of the time. Love is expressed in so so many more ways than via the medium of lactation!

If you’re a Category C reader (and you’re still reading this) please don’t let me stop you voicing your opinion. The internet also supports freedom of speech. But my happy, smiley four month old son sleeps like a professional and thrives on formula – especially when his Daddy gives him his bottle. And (I’ve just checked) he doesn’t seem to have any gills.

 

FFF Friday: “I’m thanking the formula companies for nourishing him when I couldn’t.”

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

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

This week’s FFF Friday guest post comes from Lindsay, who blogs over at You Are The Roots. When I chose the title for her post, I worried for a minute that it would come off like pandering to the formula industry, and I knew that was not at all Lindsay’s intent. But then I decided to go ahead with it, because I join her in wanting to give thanks. I may not be comfortable with the way formula companies always promote their products, but I also have a lot of gratitude in my heart for the products themselves. When my milk was making my child sick, they gave me an option. And in Lindsay’s case, they gave her the gift of being able to feed her child when her body wasn’t able to to. I think about it like this: I really dislike how antidepressants are marketed, because those tv commercials make it sound like anyone who is having a shitty day should be medicated. But the drugs themselves? They can be lifesaving to those who truly need them. Bad marketing tactics do not necessarily mean a product is inherently bad- and this concept seems to be widely accepted as truth except in the case of formula. 

Happy Friday, fearless ones,

The FFF

*** 

Lindsay’s Story

I’m a planner. Scratch that. I’m a control freak. I am terrified of the word ‘spontaneity’ and am pretty sure it causes me physical harm to have it enter my life. When I was put on bedrest during my pregnancy, it gave me ample time to make blueprints and life plans and map out what we needed and when we’d do things and how things would be and when my baby would sleep and what dinners we’d be eating and – well, there was no stone unturned. Such a militantly planned life doesn’t always go hand in hand with severe preeclampsia and many weekly appointments with specialists who consult with your doctor and tell you at the end of that appointment if your baby gets to continue to bake or you’ll have to make the hospital your next stop. There was a lot of unknown in my life at an already trying time – my first pregnancy – and I wasn’t handling it well. I think I reminded myself to mind my blood pressure at least twenty times a day, trying to turn my mind off and stop letting it wander with thoughts of all that randomness unable to be put on a to-do list to be planned and properly executed.

The one thing I knew – even if I didn’t know how many weeks I’d be when I delivered or if my baby would require the NICU or anything else that I thought I knew but no longer did – was that I was going to be a breastfeeding mother. I am guilty of being that mom who rolled my eyes at mothers mixing formula in the mall, on television, at the grocery store. All I knew was that babies were supposed to be nursed because that’s just what is supposed to happen – I mean, that’s why women produce milk, after all – and it made me so angry that some people tried to sidestep their responsibility as a mother to do the best thing for their babies. My hospital bags were packed and toted around with us from doctor visit to doctor visit, containing tons of nursing nightgowns, nursing bras, breast balms and creams and milk teas. I circled on all of my hospital paperwork that I planned on breastfeeding, underlined these words and highlighted them, daring anyone to bring a bottle near the mouth of my baby.

And then, you know, I got the last laugh. My son was to be born at 36 weeks, unexpectedly, because my body just couldn’t do pregnancy anymore. He came, my blood pressure couldn’t be regulated, I was on all types of anti-seizure drugs that render me unable to remember more than 2% of my son’s first two weeks of life. To this day, my husband will laugh and say “remember when…” and I try to mask how distraught I am that, no, I don’t remember. I remember worrying that I would die and never get to hold him and I remember falling to pieces at my 8 week check-up that I didn’t produce any milk. How could I be a mother? How could I be a woman? I wasn’t. I wasn’t worth being called either because my body had failed me again. The doctors, the nurses, the lactation consultants explained to me with all the patience and love and sympathy in the world that it was the medications, that I had to be administered these medications so that I could be here and be the mother to my son that they knew I could be, but their words fell on deaf ears. I wasn’t a woman, I wasn’t a mother, my body had failed me again, I couldn’t do anything right and my son was going to fall into that pile of obese, stupid formula fed kids I kept reading about on the internet.

Fast forward to a year later. My son didn’t fall into that pile. Mostly because that pile doesn’t exist. My son is healthy, intelligent, a wonderful eater, maybe not the best sleeper, meeting his milestones and existing as the happy, magnificent, beautiful boy that he is. And me? I’m thanking the formula companies for nourishing him when I couldn’t. Not that it was an easy road to get here to this place of solace and confidence. It wasn’t. I lived through a mother commenting on my formula-mixing, noting that it was “poison” I was feeding my child. I lived through people giving me sympathy as if I left the hospital without a child, without some limbs, as if I was fighting for my life. I lived through it all and, really, I learned. I learned that how or what you feed your child is simply a choice. I learned that the children who are starving, who are physically abused, who are sleeping on the streets and who don’t know what it means to be loved – they are the ones who need our sympathy, our compassion, our charity.

Mostly, I learned the only thing I regret are those days I wasted crying and hating myself instead of realizing how beautiful life was, and how beautiful my son was, and how lucky I was to have him here, so healthy, so happy.  I regret the time I spent thinking that I was doomed, that my son was doomed, that my family and reputation and life was doomed.

Because if you have to formula feed or if you choose to formula feed, you are not doomed. Your life, your child, your family, your reputation – none of these things are doomed. I get to kiss my son’s beautiful face when he wakes up each morning and throws his arms out towards me, yelling “mama! Mama! Mama!”, and then I sit back and wonder what I ever worried about. I have everything in the world and my everything? He has me.

***

Join the party- you know you want to. Send me your story: formulafeeders@gmail.com

 

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