City of Ottawa Public Health Unit’s “Informed Consent” webpage: A case study in (un)informed consent

An anonymous FFF reader has allowed me to publish the following letter, which she sent to her local Public Health unit in Ottawa. I visited the site that caused her so much consternation, and I was equally incensed. Please click here to see what she and I are talking about:

Make an informed decision about feeding your baby

My thoughts on the Ottawa website follow this letter. I’d also encourage you to check out the letter sent by the blogger at Awaiting Juno. And, if you’re feeling inspired to do so and happen to be a citizen of Ottawa (or even if you just feel like giving them your opinion), feel free to write your own letter and send it to healthsante@ottawa.ca.

***

Dear City of Ottawa Public Health Unit,

I discovered the following webpage on Informed Consent and was utterly dismayed at what I had read.

I had my daughter seven years ago and am hoping to have another child within the next two years. When I was pregnant with her I knew I was going to breastfeed her. I felt that formula was vastly inferior. Unfortunately having breast hypoplasia (something that none of the literature of had prepared me for), made exclusive breastfeeding an impossibility. My daughter went from losing weight on my breasts alone (I did have a postpartum nurse who was very concerned about my breasts due to their shape and spacing, but I dismissed it as an unsupportive nurse, not as her giving me relevant information on my situation), to thriving on formula.

That page isn’t giving informed consent, it is scaring women into breastfeeding by bringing up scary words like “obesity”, “SIDS” and “Cancer”, without mentioning any potential  drawbacks for breastfeeding (including not being able to take certain medication and that it can be a physically and emotionally draining experience for some) and without making any positives about formula. It also doesn’t mention that formula prepared properly is a valid feeding method and choosing it doesn’t mean that a child will end up toothless, obese, diagnosed with cancer, or dead. From what I have seen about the research the main risks are a higher rate of gastrointestinal viruses and ear infections (which my daughter did get, when she was 5 and a half years old). For a woman who might be already sad that breastfeeding isn’t working out with them, such phrasing of information without perspective or actual risk amounts could contribute to postpartum depression. I should know- seeing that kind of information online (it exists all over the internet) after switching to formula was a contributing factor to my own depression.

You mention on the first page that the Baby Friendly designation includes supporting women’s feeding choices, but I do not see how that supports a formula feeding woman at all and could increase the stigma and isolation about using a product that is in fact very safe to use in our city.

I encourage you to take that “Informed Consent” page down and rework it so that it does not demonize formula. The benefits of breastfeeding in all honestly should be able to stand on its own without resorting to demonizing formula. Furthermore, I am more than willing to help with any rewording to help formula feeding moms feel more supported in their choice.

As a taxpayer, mother and a woman who felt intense guilt for 2 years for using a product that nourished my daughter where I couldn’t (I also have the perspective that she is a very healthy, active 7 year old), I urge you to reconsider your approach.

Yours truly,

A.

 ***

Before I return to my Pad See-Ew, which is currently getting cold (yet another reason to be annoyed at the city of Ottawa – they are ruining my damn dinner), I want to add a few of my own thoughts to Anonymous’s letter.

The document on the Ottawa Dept. of Health website is coercive and factually inaccurate, starting with the first sentence. They state:

Deciding how you are going to feed your baby is one of the most important decisions you will make as a parent.

What the “most important decisions” you’ll make as a parent are is entirely subjective.

Next, they state:

Making an informed decision means you have all of the information you need to help you decide what is best for your family.

Yep. Exactly. You deserve accurate, dispassionate information so that YOU can decide what is best for YOUR family. This document does the polar opposite. It confuses correlation and causation (I only see two uses of the important qualifier “may” in the lists of benefits and risks – for example, they claim that breastfeeding “helps to protect against cancer of the breast and ovary.” It would be accurate to say that breastfeeding “may help to protect…” or “has been associated with a lower risk of…”, but the way they pronounce this benefit makes it sound proven without a doubt. This is simply not true); it does not mention any of the potential downsides of breastfeeding, nor the benefits of formula feeding (even if they’d just said “the ability to feed your child when breastfeeding isn’t working or there isn’t a mom in the picture”, it would have sufficed); and most importantly, it does not leave the reader with any choice other than to breastfeed, or feel like an inadequate, terrible human being. And before someone starts misquoting Eleanor Roosevelt to me, let me stop you: yes, people CAN make you feel guilty without your consent. Or if you can’t agree with me on that, let’s forget about guilt – how about embarrassed or judged? Can people make you feel that way without your consent? And what if you’re not in any emotional place to give that consent? Like when you are a hormonal pregnant or newly postpartum parent, and it’s your city government posting a bunch of fear-inducing drivel under the headline “the benefits or breastfeeding for the baby, mother, family and the community”? How about then?

The document’s piece de resistance is this half-assed suggestion at the bottom of the page:

If you have made the informed decision to formula feed and need information on how to prepare it safely, please visit Ottawa Public Health’s Food safety page.

Ah, I see. So if you’ve made a decision to do something that causes nothing but inconvenience, pain, and suffering for you and your child (and your community- can’t forfet your community!) based on this “information”, you should just go to a different department, because we’re freaking OVER you. Notice that when the link for more information on breastfeeding follows this taxonomy:

Residents>>Public health>>Pregnancy and babies>>Healthy baby and parenting>>Feeding your baby>>Breastfeeding

There is NOTHING about formula in this “Feeding your baby” section. Instead, formula feeding monsters, er, mothers are directed to:

Residents>>Public health>>Food safety and inspections>>Baby Formula

Apparently, healthy babies and parenting only has to do with breastfeeding. Formula feeding is on par with selling hot dogs at softball games.

I don’t even know what to say, except to all the soon-to-be moms and currently formula-feeding or combo-feeding mothers in Ottawa, I am so, so sorry. Your city health department sucks donkey balls. And if I were you, I’d start the angry tweets and emails right. Freaking. NOW.

Twitter: @ottawacity

Email: healthsante@ottawa.ca

 

 

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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23 thoughts on “City of Ottawa Public Health Unit’s “Informed Consent” webpage: A case study in (un)informed consent

  1. I saw this somewhere else, and thought the same thing. I asked the (Canadian) woman who posted it to respond in a similar fashion and tell them they were not providing enough information for women/families to make an informed decision, as they were leaving out the benefits of formula and the risks of breastfeeding. I said I would have done so, but as an American (with no infants and none forthcoming to boot), they probably wouldn’t take me very seriously.

    Anyone responding to them could even provide them with a list of formula benefits and breastfeeding risks, with citations, so they could have no complaints or arguments about it, even though it was their job to do that research in the first place. Which maybe someone else could mention, so they don’t throw the letter full of valuable info straight into the trash. There are petition sites online (where you can start any petition you want), perhaps the people of Ottawa who are frustrated by this obnoxious maneuver could start one and send it to the Public Health Unit when they get enough signatures. It may not change anything, but at least they would be heard, if there were enough of them. I’d sign it for whatever good that would do, again, taking into account I’m not even Canadian.

  2. Here is my email to Ottawa PH:

    Dear Ottawa public health,

    I’m writing in reference to this link below which claims to give information on breastfeeding vs formula feeding:

    http://ottawa.ca/en/residents/public-health/pregnancy-and-babies/make-informed-decision-about-feeding-your-baby

    In my understanding, health care practitioners are to give their clients both the risks and benefits of each choice. You have included no risks to breast feeding or benefits to formula feeding. I’m sure that some could be found and that women and their families deserve to have the full picture of what the research shows to make an informed decision. This makes your webpage appear to be more like propaganda. I believe women are intelligent enough creatures and can be trusted with the whole picture and given all the information to make their own choices. Breast milk may be the best food for babies but exclusive breastfeeding may not be best for all families.

    Thanks for your time,
    Judy Gerber-van Vliet
    Kingston, ON

  3. I’m sorry, I couldn’t finish reading the article. I had to go make sure to not snuggle and love my children. Since I FF we’re not close at all, in fact I find the need to distance myself from them as much as possible. If only I had BF, maybe then I’d want to cuddle them. Same goes for all the friends and family members who fed them bottles when they were babies.

    Then my poor brittle bones, and the extra fat I failed to lose from not BF-ing made it so hard for me to get up from my desk chair, so I couldn’t even make sure that my kids’ jaws weren’t developing correctly.

    Now, if you’ll excuse me, I have to go dust off the $300+ breast pump, bottles, and accessories that are so much cheaper than formula and get back to feeding my children poison that I made sure to prepare improperly.

    • Corri, that explains why you had to use formula! You ONLY got the $300 dollar pump, if only you bought the $500 pump, or better rented a hospital pump for 12+ months, then you would be healthy and bonded to your baby!

      • *for the record I have a $450 pump in pieces in front of me on my desk that crapped out…. I call BULLSHIT on anyone who tells me that breastfeeding doesn’t cost anything!!!

        • Thanks for making me smile. I get the “breastfeeding is free” excuse ALL THE TIME and I want to just scream and bash my head against the wall. The cost of the pumps, the cost of time missed from work due to pumping/nursing, the cost of my health (PPD, mastitis, etc.), and the cost of my sanity ALL equal much, much more than anything I’ve ever paid for formula. I actually had a mother tell me the other day I should be feeding my baby donor milk since I wasn’t able to BF. For the record, donor milk costs at least $4 per ounce, is not even available in most areas, and has been shown in many studies to run the risk of contamination…but how dare we bother to feed our child in a healthy, cost-effective manner unless we chose to be a human skin cow or pay out the wazoo. I think the BFing is free argument probably ticks me off more than any other.

          • Corri, it does need a sarcasm font!!!!

            I also spent WAY WAY more time, energy, emotion energy (mental well-being), physical tram and emotional distress breastfeeding than FFing. The relief I felt when I put away the boob and gave my boy a bottle was like 1000lbs had been lifted off me.

  4. That explains why I could not find ANY information on how to feed my baby when I weened!!! I am an Ottawa resident and I can honestly say that the culture in this city is so pro-breastfeeding that the public health nurse had no information for formula feeding when I asked at a drop-in. She apologized, and said that all the information had been redone because the were getting the Breast Feeding Friendly designation. She told me that they still had formula information, and I could find it on their webpage…. no mention that it was hidden away from the feeding your baby. Silly me went to that page!
    The culture among the birth and infant community (from prenatal classes, to public health, to mom and baby classes, to play groups) are so PRO BREASTFEEDING that the ONLY time ANYONE mentioned formula to me was to pronounce the EVILS of formula and how it was akin to poison. My husband and I were so brainwashed we were afraid to let even an ounce of it touch our baby. It wasn’t until I was seeing a therapist and a psychiatrist for PPA and PPD at 8 months postpartum that they gently asked me to consider weaning since I was in such excruciating pain from nursing! It was only once I weaned that I started to get better and could finally bond with my baby!

  5. Quick question, but has anyone made a screenshot of the Ottowa page? Because my experience is that when a page like that gets a lot of unwelcome attention, it often disappears without any warning, and then there is a lot of stuff about how the original page wasn’t actually all that bad and the formula feeders were all just over-reacting, etc.

  6. wow. that page makes me angry!!

    “Does not produce any garbage; there are no formula and bottle packages to throw out”

    Seriously? Most of their pointers are junk, but i had to laugh at that one – just sounds like they’re scraping the bottom of the barrel.

  7. Pingback: Formula Isn’t Poison — Breastfeeding Propaganda Is | motherhood is magic

  8. As someone who lives on the outskirts of Ottawa and who gave birth in Ottawa only two years ago I am so disgusted and disappointed at this page. I was so LUCKY to have such great nurses who supported my choice to FF when BF did not work out (previous breast reduction surgery). They made the whole thing feel like no big deal and were pointing out all of the pro’s to formula feeding to me and even snuck two full cartons of the sample formula packs in my bags to take home!! However when I came home having no idea how to formula feed and asked my local health unit for information I was brushed off as “its not really that hard read the label” and given a 1 side page handout on sterlizing bottles. I’m pregnant with my second and after reading this I already feeling like my second hospital stay might not go so smoothly. Good thing I have the confidence in my choices now that I might not have had with my first (who has always been healthy and ahead of all his milestones!)

  9. I suppose there is Informed Choice and then there is Misinformed Choice. FWIW this webpage doesn’t say that you have to have Correct information when you make your choice. 🙂

  10. Apparently Toronto’s (yes home of Crack-loving mayor Rob Ford) – webpage on infant feeding is just as bad as Ottawa’s. Further – of the responses I’ve seen to the emails that have been sent, they’re pretty much all the same and brush off the criticism of the information provided.

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  12. Pingback: It's Time To Rethink Feeding Support, Info Given To New Parents | Localized.US

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