A public health perspective on formula use & breastfeeding advocacy – Guest Post

I’m incredibly thankful that someone in the field of public health is taking a stand on how we ignore the reality of formula use, and I really hope others will follow. We need decision-makers and influencers – physicians, scientists, public health professionals, nurses, politicians, hospital administrators – to start looking more closely at these issues, and to speak up when they see flaws in the current system. It’s the only way true change can happen.



A public health perspective on formula use and breastfeeding advocacy:

What we don’t say matters


by Hillary Kuzdeba, MPH


In the United States, the majority of babies will receive formula at some point during their first year. Despite what we may personally believe about the importance of breastfeeding, it is critical that medical and public health professionals keep this fact in mind when we design infant feeding educational initiatives for families. When we fail to discuss formula with families, or worse, when we purposefully withhold information on formula from them, we are doing families and infants a great disservice.


Today, most of the breastfeeding advocacy programs implemented in hospitals, birth centers, and OBGYN/midwifery practices utilize a two pronged approach to encourage breastfeeding. The first method, which is the active promotion of breastfeeding, is immediately apparent. Women are empowered to breastfeed through intensive educational materials, classes, consultations, and support groups. The second method is less noticeable, but important nonetheless. Here, strategic obstacles deter women from formula feeding. The obstacles include the reorientation of discussions about formula back towards the “breast is best” message, limiting access to formula during hospitalization, and generally withholding any information on formula lest it “encourage” the family to use it. Used in tandem, both methods create an environment where breastfeeding is presented as the only healthy feeding option. This is why pro-breastfeeding institutions rarely disseminate any information on formula feeding, except to mention that it is suboptimal. In these environments, families will find a myriad of resources on lactation, breastfeeding positions, latching, pumping, and other breastfeeding topics. Meanwhile, practical guides discussing formula selection, appropriate mixing, safe storage, and feeding have been almost completely eliminated.


The first method employed by these programs is wonderful. Most of us agree wholeheartedly that women who want to breastfeed should receive extensive support. I did, and I am so thankful for the resources that helped me breastfeed for as long as I did. But it is the second part of the advocacy approach that worries me, both as a public health professional and a mother. The strategy of withholding health information from patients and families, out of a misguided fear that more information might encourage an undesired behavior, has long been debunked by the scientific community as ineffective and potentially harmful. And yet we continue to implement this strategy in regards to formula feeding.


Some public health researchers, advocates, and other parties may balk at this statement. They may point to evidence suggesting that placing obstacles in the path of a decision can “nudge” individuals towards a different choice. That may be true in specific instances, such as smoking or alcohol use, where the undesired behavior is recreational, unnecessary, addictive, and downright harmful. But infants must eat, formula is a proven healthy option, and breastfeeding can be very challenging for numerous physical, psychological, and social reasons. Most women in the US initiate breastfeeding. So when they do use formula, it is usually a conscious decision for reasons outside of personal preference. Withholding information from these women does not “nudge” them towards breastfeeding. A lack of knowledge about formula does not make extreme nipple pain disappear, or milk flow. It does not change a baby’s mouth structure, or eliminate a working mom’s 12 hour shift. All it does is create the impression that a parent has no option other than breastfeeding.


How does this strategy really play out?


  • When a parent who is aware of the benefits of breastfeeding still wants to talk formula, twisting the conversation into another discussion of how “breast is best” is not education – it’s intimidation. This behavior alienates and stigmatizes her, while simultaneously undermining her intelligence and personal authority. It is a form of intellectual bullying, and it delays the provision of requested education on formula feeding. When we use this approach, the message we are sending is clear: “You must not be aware that formula is a poor choice. Let me reeducate you because you clearly aren’t getting it. Maybe now you’ll come to the right decision.”


  • If a woman is really struggling to breastfeed and we oppose her when she requests formula, we create a power struggle with a vulnerable parent who is just trying to feed her child. This undermines her trust in us and causes anxiety. She may begin to question whether we really care about her and her infant. This can be devastating for our relationship with poor women, minorities, or other groups who already have reason to be suspicious of the medical establishment or government due to past medical and scientific abuses.


  • When we send new parents home with absolutely no education on even the basics of formula feeding like appropriate bottle cleaning and safe storage, we are purposefully withholding critical safety information that could potentially result in harm to an infant. Even parents who appear committed to exclusive breastfeeding should still be educated on these subjects given that most will end up using formula at some point. Assuming they won’t need this information is wishful thinking.


Worst of all, when we create an environment that strongly implies that we are against formula, we accidentally send the message that breastfeeding should be prioritized above all else, including the health of mother and baby. In this environment, our silence on formula use speaks volumes. It overexaggerates the risks of not breastfeeding to the point where mothers may actually endanger themselves and their babies in a desperate effort to avoid the dreaded F word. No mother should be so hesitant to give her child a bottle that the baby ends up hospitalized for extreme dehydration or malnutrition. No mother should be so afraid of formula that she spirals into depression over her inability to breastfeed. And no mother should be led to believe that formula is so risky that she is willing to turn to unscreened, unregulated human milk from an anonymous stranger on the internet to feed her child. And yet, this is happening every day across the US.

Educating families on safe formula selection, preparation, feeding and storage in no way undermines breastfeeding. If a mother is committed to exclusive breastfeeding, providing her with an extra handout on formula use is not going to change her mind. But including that same information can make a world of difference to a family who finds themselves in need of formula. When we include formula in our discussions, our classes, and our educational materials, we create a safe space that shows parents we are on their side – regardless of how they feed their baby. I think that is a strategy we can all get behind.

Hillary Kuzdeba holds a Master of Public Health (MPH) with a focus on social behavioral science, health promotion, and women’s health. Over the last few years, she served as the program coordinator for a large nursing research group at a renowned Children’s Hospital. Today, she spends her days at home taking care of her beautiful, formula-fed daughter.

“Mothers deserve better”: An interview with Dr. Christie Del Castillo-Hegyi

Dr. Christie Del Castillo-Hegyi, MD, is a mother – and a physician- on a mission. Since she began her blog and Facebook page a few months ago, she’s become a hero to over 10,000 parents who have experienced insufficient milk or delayed lactogenesis II (the process of breastmilk “coming in” after birth). She has been tirelessly advocating for better safeguards for breastfeeding mothers, and fighting against the dogma that insists that supplementation is detrimental to a baby’s health. 

I’m honored to bring you this interview with Dr. Del Castillo-Hegyi. Her opinions are controversial, and I really admire her bravery, and how she’s turned a negative personal experience into a plea for change. Before we make blanket recommendations that force women to weigh their gut instinct against the fear of recriminations from medical professionals and hospital staff, it’s essential that we look at ALL the research- without bias, without blinders, without fear. 

– The FFF

“Mothers Deserve Better”:

An Interview with Christie Del Castillo-Hegyi, MD.

FFF: Your blog and Facebook page are called “Insufficient Breastfeeding Dangers”. What are the dangers of insufficient feeding in a newborn, exactly?

CDCH: The known potential effects of insufficient feeding are dehydration, low glucose, elevated bilirubin (jaundice) and high sodium.  All in all, those laboratory markers make up the syndrome of starvation.  Dehydration, if extreme enough, can cause decreased circulating blood volume, low blood pressure, and decreased circulation to the brain.  This can cause brain injury and even death.  In animal studies, thirty minutes of loss of circulation to the brain can cause widespread brain cell death.


Extreme dehydration results in hypernatremia, or high sodium, because as a baby loses water, the sodium will become concentrated.  Their brains can experience contraction similar to dehydrated fruit, which upon re-expansion through rehydration, can result in brain swelling and irreversible brain injury.  It has been documented in the literature that hypernatremic dehydration can result in brain swelling, brain hemorrhage, seizures and even death.


It is not clear how long a child can tolerate exclusive colostrum-feeding before they develop hypoglycemia.  I have had one mother whose child seemed dissatisfied from exclusive colostrum-feeding for only one day and was found hypoglycemic by the second day.  It is difficult to know what the typical time to developing hypoglycemia of an average exclusively breastfeeding child because glucose is not routinely checked in babies without a diabetic mother or other traditional risk factors.  Hypoglycemia eventually happens to all babies if they do not receive enough milk through breastfeeding either due to poor supply or poor latch.  EVERY article in the known medical literature that has studied newborn hypoglycemia shows evidence of harm in the form of abnormal MRI findings and decreased long-term cognitive outcomes.  A low glucose is typically cited as a glucose level of less than 45, even though some newborns may exhibit few signs of distress even at this level.  Signs of a hypoglycemic newborn is agitation, frantic feeding, inconsolable crying or lethargy.


Lastly, insufficient feeding can result in a third dangerous condition, called hyperbilirubinemia or jaundice.  A bilirubin of greater than 15 is considered abnormal in the literature and has been associated in multiple studies around the world with a higher risk of autism relative to newborns who don’t experience high bilirubin levels.  One study refuted these findings and it came from the Kaiser system, which is a Baby-Friendly hospital, where exclusive breastfeeding from birth is encouraged.  They produced a study that was well-done but was thousands-fold smaller in size that the largest study, which showed a positive correlation, in Denmark, where they studied the ENTIRE newborn population over 10 years, which included over 700,000 newborns.  The Denmark study found a 67% higher risk of autism in jaundiced newborns.


That being said, I don’t want to worry every mom whose child had jaundice.  Not every jaundiced newborn has a level above 15.  Also, not every child who develops a level above 15 will develop autism.  Autism is still a genetic disease.  I believe babies who are born with a lot of autism genetics, as predicted by having lots of scientists, mathematicians and engineers in their families, who experience a physiologic insult, such as lack of oxygen to the brain and jaundice (both demonstrated in the literature to be associated with autism) may go on to have the disabling condition of autistic spectrum disorder.

FFF: What sparked your interest in this issue?

CDCH: My newborn son developed hypernatremic jaundice and dehydration because I was assured by the breastfeeding manuals that there is always enough milk in the breast as long as I keep breastfeeding.  I was told that, “he would be hungry” and that my “latch was perfect” by our lactation consultant the day we left the hospital.  No one ever told me it was possible for a child to become dehydrated and unconscious because there was not enough milk present.  We were told to count the diapers but how wet is a wet diaper?


My son lost 15% by the third day, the day after discharge and my pediatrician must not have calculated the percent lost because he gave us the option of continuing to breastfeed and to wait for the 4th or 5th day.  I realized when I was watching my son get an IV that what I did must be common and that other mothers must be experiencing this horror too.  I thought, “What must my son’s brain injury look like and why hadn’t I heard of this before?”  Three-and-a-half years later, I found out what his brain injury looked like.


What I saw with my own physician- and mother-eyes was the slow torture of a newborn child.  Babies who are asked to endure hours of frantic feeding without compensation of milk, otherwise known as “cluster feeding,” are experiencing agony.  No textbook, lactation consultant or physician will ever convince me otherwise.  To this day, the description of what I saw is embedded in every breastfeeding manual as normal and vital for the stimulation of milk production.  We are systematically telling new mothers to ignore their child’s hunger cues by telling them there is ALWAYS enough colostrum and by scaring them into withholding formula even when a newborn needs it.  THAT is why newborn dehydration will never go away with simply increasing breastfeeding support and follow-up appointments.  Unless a mother is given the knowledge about the potential harms of insufficient feeding and the right to feed her own baby, newborns will continue to experience these complications and be hospitalized for it every day.

FFF: When you began researching the topic, was there anything that surprised or shocked you?quotescover-JPG-66

CDCH: I began researching the topic shortly after receiving our son’s formal diagnosis of autism, which was February, 2014.  I first studied jaundice and autism and was surprised that there were so many studies that linked the two conditions, because I had never heard of the risk factor listed in the patient literature on autism.  I wondered why a modifiable risk factor would not be heavily attacked in the face of an epidemic.  I believe it is because it is linked to breastfeeding.

Breastfeeding has enjoyed an untouchable status in the medical community.  So much so that no part of it as outlined by the lactation community has been challenged by the physician community.  We assumed because it is associated with breastfeeding, what ever the guidelines are must be safe, despite evidence that many newborns on a daily basis get admitted for dehydration and jaundice from exclusive breastfeeding.  Unfortunately, any challenge is quickly met with an accusation that the individual is “anti-breastfeeding” or “pro-formula,” when in fact, perhaps it may simply be a challenge like mine, whose purpose is to keep the newborn safe from harm.  I am surprised by the lack of activism by the medical community to reduce or stop the incidence of a horrible, life-threatening and brain-threatening condition that can be prevented with informing mothers of these complications and a few bottles of formula to keep a child out of the hospital.

quotescover-JPG-42I was surprised to find out that we really haven’t exclusively breastfed from birth for millennia before the creation of formula.  If that were so, indigenous cultures that have no access to formula currently would be doing so nearly 100% of the time.  In fact, there is no evidence that we have widely exclusively breastfed from a single mother at all.  According to a review of the history of breastfeeding written by an IBCLC, lactation failure was first described in Egypt in 1550 B.C.  Wet nurses were often employed to feed newborns whose mother could not lactate.  There are modern day cultures where babies are breastfed by a community of mothers, not just one mother.  Also, the breastfeeding literature is rife with articles showing how problematically low exclusive breastfeeding from birth is all around the world because most cultures give what they call, “pre-lacteal feeds.”  These moms probably just call it “feeding.”  Moms all over the world recognize that their children may need more than what is coming out of the breast and they have populated their countries on the tenets of feeding their children what they need every day.  It wasn’t until the breastfeeding resurgence in the 1980’s and the codification of exclusive breastfeeding from birth through the Baby-Friendly Hospital Initiative of the World Health Organization written in 1992, that we started feeding newborns colostrum-only during the first days of life in the hospital.  This was written primarily to counteract the dangerous feeding of formula prepared with contaminated water to babies in the developing world, which was an important public health endeavor.  However, the guidelines to exclusively breastfeed for 6 months largely ignored the common possibility of insufficient milk production experienced by many mothers.  So feeding newborns without supplementation only began in the 1990’s.

Nurses who worked in the newborn nursery in the 1980’s account that newborns were supplemented from the first day of life with 2 ounces of formula.  Most newborns tolerated these feeds and did not vomit it as widely claimed by the lactation community.  I found that the newborn stomach at birth is not 5 cc, as claimed by the lactation community.  It is in fact roughly 20 cc’s or 2/3rds an ounce, as summarized by a review of 6 different articles looking at actual newborns.  This is also the static volume of a newborn stomach and may not account for peristalsis, which may allow a newborn to accommodate more.  I discovered that it is quite implausible that the stomach can grow 10 times its size in 2 days and that a one-day-old newborns can in fact drink 2 ounces in one meal without vomiting at all.

Many moms asked me, “How much weight CAN they lose?” and “What DOES my newborn need?”  I looked again to the literature looking for evidence showing the safety of weight loss in newborns and NOT A SINGLE ARTICLE showing that 10% weight loss over 10 days is safe in every newborn, which is the current standard of care.  This teaching has been accepted for decades now.  To answer the second question, I sought out what a one-day-old’s daily caloric requirement was and what the caloric content of colostrum is.  I found that a one-day-old’s caloric requirement is the same as that of a three-day-old’s, because they have the same organs and same activity all three days.  A one-day-old newborn needs 110 kcal/kg/day and colostrum has 60 kcal/100 mL.  I must have done this calculation by hand 20 times because I found that this resulted in a one-day-old needing 2.8 ounces of colostrum per pound per day .  A 7 lb child would need 19.6 oz of milk in one day.  I confirmed this finding because I gave my 5.5 lb twin girls free access to supplementation and they each took 2 oz every 3 hours on their first day, a total of 16 oz.  They only gained 1 oz! That leaves 15 oz going completely toward their metabolic activity.  For them, they required 2.7 oz/lb/day.

How much actual science and observation of actual babies and safety data was done to come up with the breastfeeding guidelines?  There are many articles that show that unlimited supplementation can reduce breastfeeding duration, which is why formula is withheld from babies, but none that showed this practice was safe for the baby’s brain in the long run.  We have no idea what threshold of weight loss is in fact safe for a baby’s brain, because it has not been studied.  While babies’ bodies can endure days of underfeeding, their brains cannot.  That is what I am asking the scientific community to study.

FFF: Do you think that medical professionals are afraid to say anything that could be construed as “anti-breastfeeding”? How have your peers responded to your work in this area?

CDCH: Yes, medical professionals are afraid to say anything contrary to what the lactation community accepts as true because they do not want to be perceived as “anti-breastfeeding” or “pro-formula.”  Being “pro-formula” or “formula-sponsored” is a common accusation that I receive despite all the “pro-breastfeeding” instruction that I provide.  People have assumed that if you are against any part of the breastfeeding prescription, you MUST be against breastfeeding.

I am absolutely pro-breastfeeding.  I am absolutely AGAINST starving a child to achieve it.  I have received quiet support from several of my peers, but mostly silence for the majority.  I believe colleagues who are silent are incredulous or shocked or afraid.  I can’t truly know.  I can understand it because I am a physician and we are taught to stick close to the pack.  I am literally running away from it.

Until there is data from a credible and impartial source like the CDC or the Joint Commission, I will not have the proof that the Baby-Friendly Hospital Initiative is causing long-lasting harm.  There is already plenty of harm that has resulted locked in the hearts of many mothers who experienced this trauma.  I hope moms from both our Facebook sites will be willing to help advocate for increased safety for newborns by submitting written and/or video testimony on how the BFHI harmed them and their child.

FFF: What sort of response have you received from publishing your blog and Facebook page? 

CDCH: Outrage from breastfeeding moms and opposition from most lactation consultants except for a loved few, two of which fully recognize the harms of insufficient feeding to baby’s and their moms.  However, the ones I live for are the responses from moms who say that this happened to them and their babies either were harmed, hospitalized or were luckily saved from harm by an independently minded mom, nurse or other individual that told them their baby was hungry and needed a bottle.  These moms write to thank me for validating what happened to them and for telling them that this was not their fault, that what they saw was real and that this should never happen to any mother and child.  I have received messages from moms experiencing what I describe in my letter in real time and I have helped those moms advocate for their child, even when their professionals were bullying them to keep withholding formula!  It’s crazy.  What are we doing to our newborns?

What I feel most disappointed about is the lack of response I have received from the Executive Committee of American Academy of Pediatrics who I have been trying to contact for at least 6 months.  No response from the organization that is supposed to protect our newborns.  So I decided to inform the public on my own.  At first I was afraid.  Now I am not.

FFF: Have you endured any personal or professional attacks due to asking these tough questions about our current protocol for early breastfeeding?

CDCH: Tons.  People on the internet can act with cruelty because they don’t have to suffer any consequences.  I try not to let it get to me because I know it comes from a place that is likely sincere like mine, a mother trying to protect her newborn from harm.  Some mothers perceive my ideas as harmful, likely because the thought of starving your child is so horrible, I get the most harsh messages from breastfeeding moms, often moms whose children developed pathological weight loss.  I haven’t received too many challenges from physicians though, interestingly enough.  At least among my colleagues on Facebook, I have received supportive messages.

FFF: In an ideal world, how do you think hospitals could alter their procedures to better protect babies and mothers from the dangers of insufficient breastfeeding?

CDCH: These are my core recommendations:

1) Instructional videos on manual expression to check for the presence of colostrum.  Mom should also be instructed on listening for swallows to detect transfer of milk.


2) Pre- and post-breastfeeding weights to ensure transfer of milk and identify newborns at risk for underfeeding.


3) Calculation of the 7% weight loss threshold at delivery so that a mother knows when supplementation may be needed, which can be posted in her room.  The most critical clinical data an exclusively breastfeeding mom needs to know is the percent weight loss of her child.


4) Universal informed consent and thorough counseling on the possibility of underfeeding and jaundice due to delayed or failed lactogenesis and giving mothers permission to supplement their child if they go under the weight limit at home using a baby scale. Mothers must know the signs of a newborn in distress including hours of feeding continuously, crying after unlatching, and not sleeping. Most of all, a mother should be advised to check her supply by hand-expression or pumping to ensure that her child is in fact getting fed.  If little milk is present, she should be given permission ahead of time to supplement by syringe with next-day follow-up with a pediatrician and lactation consultant to assess the effectiveness of technique and transfer of milk if such an event arises.

5) Uniform daily bilirubin (abnormal total bilirubin > 14) and glucose checks (abnormal glucose < 45) for exclusively breastfed infants who are losing weight or who have any degree of jaundice.  Both these values are critical to detect physiology that can cause brain injury.

6) Twice daily weight checks in the hospital and at home until lactogenesis and consistent milk transfer has been established with a mother-baby dyad.  These can be plotted before discharge to predict the expected weight loss the day after discharge if mother’s milk does not come in.  A mother can check the weight at home and supplement if the child reaches the weight loss threshold.

7) Detailed instructions on supplementation only after nursing to continue the stimulation needed for milk production.  Supplementation should be a choice and be accepted and supported by the medical community as a patient right.  A mother has the right to feed her child above all goals the medical community has for her.

8) A breastfeeding safety checklist to reduce medical error in the care of a mother and exclusively breastfed newborn.


Lastly, my advice for new mothers at home is to have an experienced parent around for the first week to help.  Parents need sleep and they don’t get much in the postpartum period.  Additionally, experienced parents know the look and sound of a child who is hungry or in distress.  The child’s wishes should be honored.  I believe in the human rights of a newborn to be fed what they need because following the alternative can lead to what my son experienced.

FFF: Your page grows in popularity every day. Have you been surprised at how many mothers have been affected by this issue?

CDCH: I am not surprised by how many mothers have experienced this issue.  Mothers have been experiencing this for 2 decades now since exclusive breastfeeding from birth has been the mandate.  This is the first that the experience is being made public because mothers have been uniformly shamed for having their child go through this.

Even now, people still post comments that blame me for not knowing, for not producing enough milk, for not seeking out enough help when the entire teaching by the lactation community prevents a mother from knowing this is possible and the standard of care does not detect what is coming out of a mother’s breast.  We have been taught to abandon responding to a baby’s cry in order to achieve exclusive breastfeeding and rely instead on weight checks and bilirubin levels to determine “medical necessity” for supplementation.

What are we doing with our newborns?  What are we doing to our mothers?  It breaks my heart every day the things mothers have told me about inadvertently starving their newborns.  They all sought help and all followed the instruction of their providers while seeing that there was something wrong with their child.  But they were told breastfeeding is always enough as long as your child is producing diapers.  What we are doing is NOT enough. These are the most well-intentioned and motivated mothers who do this. They read parenting books, attend classes and follow their doctor’s orders like I did.  I was in the hospital for a whole 48 hours while my son was receiving nothing for me!  Then I was at my pediatrician’s office the next day, at a lactation consultant’s office the day after and in the hospital by that evening.

Mothers are being led astray by the current breastfeeding dogma and being led to hospitalize their precious babies.  These mothers deserve better.

Vist Dr. Del Castillo-Hegyi’s Facebook page for more information: https://www.facebook.com/insufficientbreastfeedingdangers?fref=ts



#ISY Week Guest Post: A nurse’s perspective on infant nutrition and self-advocacy

The following guest post was written by Maria Elena Piña-Fonti, President of the National Association of Hispanic Nurses—NY Chapter, in honor of #ISupportYou Week. I was thrilled she wanted to contribute something, as nurses play an integral part in ensuring that new parents and their infants get the healthiest start possible, while respecting the need for autonomy and an individual approach to care. I hope more health care providers will join Maria in celebrating ISY Week, by helping new parents understand their rights, offering education in a culturally sensitive manner, and showing the world the true meaning of “informed choice”. 

Infant Nutrition and Self-Advocacy

by Maria Elena Piña-Fonti, MA, RN

As a nurse, I come in contact with parents from all walks of life.  First-time parents, experienced parents, confident parents, and sometime confused parents.  What I tell parents—both the mothers and the fathers—is that it is important to have as much information as possible about all types of infant nutrition in order to make an educated, confident decision about what is best for your family.

Exclusive breastfeeding, formula feeding, and combination feeding are all safe ways to feed an infant.  Parents are given a lot of information, advice, and opinions, on caring for their children—especially when it comes to infant nutrition.  But how mothers and fathers feed their baby is a personal decision, one that can be influenced by many factors such as medical issues and returning to work.

As parents, once you make an informed decision about how to nourish your baby, you—and your choices—should be respected and supported.

You are your own—and your baby’s—best advocates to ensure that you have access to all the information and support you need to be successful parents and to raise healthy and happy children.  You should feel comfortable with your choices and confident and empowered that you know best what is right for your own family.

The following are some helpful tips to help advocate for you and your baby:

1.  Speak up. You and your healthcare providers are a team working together for the health and well-being of your baby. You should always feel like a valued and respected member of this team. Don’t be afraid to ask questions about your choices and preferences.

 2.  Be open and honest. Share with your healthcare provider any concerns regarding health conditions or employment that may impact breastfeeding, formula feeding, or a combination of the two. They can only help you if they know the complete picture.

3.  Make your needs and wishes known and respected by your network, family, and friends.  Once you’ve made up your mind, make it clear that you have considered all of the information and are comfortable with your decision.  Ask for their support of your decision.

4.  It’s okay to change your mind.  If your feeding plan is not going as you wished, it’s alright to change your plan. Don’t be upset.  You have not failed. Remember the importance of closeness and touch to a baby.

5.  Get answers and information.  Your healthcare provider should fully support you and can refer you to resources you may need in making the best decisions for you, your baby, and your family.

Nobody knows the needs of you, your baby, or your family better than you do!

What parents need most is support, not shame or judgment.  #ISupportYou parents who breastfeed, #ISupportYou parents who formula feed, #ISupportYou parents who combination feed. No matter how you feed your babies, #ISupportYou.

Maria Elena Piña-Fonti is President of the National Association of Hispanic Nurses—NY Chapter, an association dedicated to community advocacy and well being, which believes parental engagement, education, and choice is essential to parental empowerment.

All new parents deserve a place at the consumer protection table, not just breastfeeding ones: A response to the “Day of Action: Keep Infant Formula Marketing Out of Healthcare Facilities”

Public Citizen is known for its advocacy for ordinary citizens who have been harmed by large entities–and rightly so.  Much good has been done by this organization in the name of everyday citizens who otherwise have little power to lobby our government for stronger laws and regulations to protect our society.  However, Public Citizen’s recent event, “Day of Action: Keep Infant Formula Marketing Out of Healthcare Facilities,” does not accomplish the goal of protecting consumers.  A consumer protection advocacy organization has an obligation to women to support their right to bodily autonomy, as well as support their and their children’s health care needs—issues that are sometimes incompatible with breastfeeding and do not currently receive sufficient support in our breastfeeding-centric post-partum health care model.

The Day of Action fails to address many of the true issues that affect women’s and children’s ability to breastfeed.  A complete lack of formula advertising is not going to enable women with insufficient glandular tissue (IGT) to make sufficient milk, or change the fact that many women have to take necessary medications that are incompatible with breastfeeding.  It is not going to prevent complicated births or medical conditions in babies that sometimes make it exceedingly difficult – or impossible –for moms to breastfeed.  It does not reduce adoptive or foster families’ need for formula.  And a lack of advertising is not going to change the fact that some women do not want to breastfeed, and have a right to their bodily autonomy.  While we agree that it would be best for parents to receive information about formula from a non-profit source, currently, there is no such source that provides accurate, unbiased formula information, even to families for whom breastfeeding is not an option at all.

The Day of Action implies that information about formula is plentiful and accurate.  Nothing could be further from the truth.  Information about formula is typically riddled with fear mongering about not breastfeeding and uses value-laden language that assumes women who use formula lack perseverance or are selfish, lazy, uneducated, immoral, or ambivalent about their children’s health, despite ample evidence to the contrary. Formula supplies in hospitals are hidden in drawers or even locked up.  Lactation consultants are held to the WHO Code and urged not to discuss formula unless under special circumstances (lest it send a message that formula is “just as good as breastfeeding,” even though it is a medically appropriate option, and sometimes the only option).  Doctors are not taught about formula preparation and are frequently scared off of even talking about formula for fear of being labeled anti-breastfeeding.  Where are formula-feeding families supposed to get the accurate, unbiased, judgment-free information they need?

Perhaps Public Citizen is unaware of the extent to which breastfeeding marketing relies on shaky claims.  Maternity wards are typically papered over with literature that claims breastfeeding improving babies’ IQ and helps new moms lose weight—claims that some assert are based on poorly-done research that frequently confuses correlation with causation, and that have not been borne out in more powerful, well-designed studies.  Recent research on breastfed and formula fed siblings (three well-regarded published studies[1]) showed little to no long-term effect of breastfeeding for a number of oft-mentioned issues.  These studies are powerful because, unlike many other studies on breastfeeding, variables such as parental IQ, educational status, and socio-economic status are much better controlled.  Several large metastudies (including those conducted by WHO[2] itself and the United States’ Agency for Healthcare Research and Quality[3]) have found that the evidence in favor of breastfeeding is marred by confounding factors.

A consumer protection advocacy organization has the responsibility to ensure that advertising claims are based on sound science, but the “absolutes” plastered on maternity ward walls, city buses, and doctor’s offices (“Breastfeeding prevents asthma[4]”, “breastfeeding makes babies smarter[5]”, “Breastfed babies grow up stronger, healthier and smarter[6]”) and liberally sprinkled in literature distributed to new parents do not fulfill this criteria. Public service messages cannot be immune to the regulations that restrict other advertising.

Further, perhaps Public Citizen is unaware of how much of the advertising for breastfeeding actually benefits corporate entities.  New moms in hospitals are given sample tubes of Lansinoh nipple cream, Medela breast pads, and coupons or ads for local boutiques that sell breastfeeding products such as Boppy nursing pillows and covers.  It is common for new mothers to receive sample magazines, which exist both to promote themselves as well as the advertisers within. It seems counter to Public Citizen’s goals to protest one form of advertising and not others.

Women deserve to know the full range of medically viable options for feeding their children, in an unbiased, accurate, and judgment-free manner, and we feel a consumer protection organization should be at the forefront of that fight.  Formula feeding parents need help, advice, and support just as much as breastfeeding parents. Unless Public Citizen is willing to help establish a non-profit center to train “infant feeding consultants”, not just “lactation consultants,” whose job is to support all medically viable methods of feeding a baby, this Day of Action seems just another way to deny formula-feeding families what little information they can still get about their health care options for their children.  It seems to contradict the stated goals of Public Citizen to protect consumers.

We encourage Public Citizen to speak with actual formula feeding parents, many of who feel marginalized in our healthcare system for the choice or necessity of formula.  Breastfeeding—and products and service providers who support it—is so heavily promoted in hospitals that formula feeding families are left without the kind of education or support that breastfeeding families receive. As there are no non-profit sources of education for formula, other than a few websites run by mothers who have taken up the charge, companies are the only remaining source. This is not ideal, but it is currently all we have. We encourage Public Citizen and all who support this Day of Action to read the stories of actual formula-feeding parents, the vast majority of whom report seeing no advertising prior to using formula, at FearlessFormulaFeeder.com, and consider how they may equitably represent the needs of pregnant, birthing, and post-partum mothers and their babies at the consumer protection advocacy table.


Concerned Members of the FearlessFormulaFeeder.com Community



[1] Evenhouse, Eirick and Reilly, Siobhan. Improved Estimates of the Benefits of Breastfeeding Using Sibling Comparisons to Reduce Selection Bias. Health Serv Res. Dec 2005; 40(6 Pt 1): 1781–1802; Geoff Der, G David Batty and Ian J Deary. Effect of breast feeding on intelligence in children: Prospective study, sibling pairs analysis, and meta-analysis. BMJ 2006;333;945-; originally published online 4 Oct 2006; Colen, Cynthia G. and Ramey, David M. Is breast truly best? Estimating the effects of breastfeeding on long-term child health and wellbeing in the United States using sibling comparisons. Social Science & Medicine, Volume 109, May 2014, Pages 55–65.


[2] Horta, BL and Victora, CG Long-term effects of breastfeeding: A systematic review. World Health Organization, 2013.

[3] NIH Agency for Healthcare Research and Quality (AHRQ). Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries. Evidence Reports/Technology Assessments, No. 153, April 2007.



Guest Post from Jessica of The Leaky Boob: Tough Love

I’m cross-posting this excellent piece from Jessica Martin-Weber, creator of The Leaky Boob, because… well, I think that will be obvious once you read it. THIS is what #ISupportYou is about. THIS is what the FFF community stands for. Working together to ensure that all mothers are supported. Not pushing breastfeeding on those who don’t want to; not cutting down breastfeeding to make ourselves “feel better’ about formula feeding; not advocating for one method over another…. It’s about helping mothers feel confident and educated and celebrated for doing the best they can for their families and themselves. Jessica is a wonderful example of what true breastfeeding support can and should be. and the fact that she is taking a stand against someone who is harming both her community and ours (and of course, they often intersect, since so many of us are not firmly entrenched in specific “camps” like some would have us believe) is seriously awesome. 

So enjoy.  And share. 

– The FFF

by Jessica Martin-Weber

Sometimes tough love is necessary, sometimes people getting in your face, calling you names, and yelling at you totally works as motivation. Usually motivation to punch them in the throat but hey it’s motivation. Entire “reality” TV shows have been built on this premise: you can scream troubled teens onto the right path, personal trainers can belittle overweight individuals into exercise and healthy eating, and business moguels can rant apprentices into savvy executives. In spite of all the studies that show that shaming doesn’t actually provide any kind of lasting intrinsic motivation, countless parents, self-help gurus, educators, and others in positions of influence and authority resort to shaming in a desperate attempt to inspire positive change. Sometimes tough love really isn’t tough love, it’s a power trip down false-sense-of-superiority lane.

Even those purporting to support families. Birth, breastfeeding, and, ironically, gentle parenting advocates, far too often resort to shaming other parents. Because that makes sense, something negative is going to have a lasting, positive impact. Undermining parents’ confidence surely is going to result in change for the better, right?


It may get your website page views, it may increase your “talking about” numbers on Facebook, it may even get people pinning your content on Pinterest. But helping people? Not likely. Inspiring them to do something different? Maybe but that may just be to ignore any information or support because it all starts to feel like an attack. I’m not talking about guilt here (though wishing guilt on people is just nasty) but rather intentionally belittling, mocking, and dismissing others in order to induce shame and build a false sense of superiority. Guilt is one’s own feeling and sense of grief over perceived wrongdoing (sometimes legit, other times not) so believing that what they did was wrong, shame is one’s own feeling and sense of grief over their personal ability of perceived wrongdoing (sometimes legit, other times not) so believing that who they are is wrong. Shaming is intentionally trying to make someone not only feel guilt but to internalize it as believing that somehow they are bad/lazy/stupid/unloving/pathetic/unloveable/worthless as a result. Ultimately, shaming comes from a desire to see someone feel bad about themselves.

It’s disgusting. And it doesn’t work to motivate people to change their actions. It isn’t education, it isn’t support, it is really nothing more than abuse.

I’ve shared before that I’m not really passionate about breastfeeding. I mean, I am, but I’m not actually passionate about breastfeeding. What I am passionate about is people and personally, I don’t see how you can actually be passionate about breastfeeding but not be passionate about people. To do so would mean that you care less about people than you do about being heard as right. Do you know what happens with that kind of passion? It hurts people and detracts from the message you are trying to promote. That kind of passion becomes easy to dismiss at best, damaging at worst.

The Leaky Boob isn’t about that kind of passion. The information, images, stories, and interactions we share are meant to inspire and encourage people. While we can’t control nor are we responsible for the emotions of others, we don’t intentionally try to manipulate others’ feelings. Underlying everything at TLB is respect and the belief that with genuine support and information, women are perfectly capable as mothers to make the best decisions for their families based on the information and resources available to them in their individual circumstances. We don’t assume to know what that looks like for anyone.

So it was with horror that we discovered an image of one of our own volunteer admins originally shared on The Leaky Boob Facebook page and then on theleakyboob.com had been turned into a vehicle intended to shame, belittle, and attack certain mothers. An image that was shared to inspire and encourage, to give someone the platform to share their own personal story and breastfeeding journey, had been used as a vile expression of superiority intended to hurt others. Words were applied to this image communicating the very opposite of what TLB and Serena, the woman pictured, stand for as a community. Without permission, Serena’s image was used to spread a message she in no way condones aligning her with those that would bully others.

This message is not approved TAP serena

I’m not going to lie, I am incensed. For my friend, for my community, and for those hurt by this image, I am outraged. Disgusted.

The person that perverted this image stole Serena’s photo and manipulated it in order to send a shaming message to formula feeders. In a statement to me Serena expressed that she felt violated and used. Not only that, but as a woman that has both breastfed and formula fed, Serena’s own image was used to attack a group of women to which she belongs as well.

When I opened FB this morning to a message from a concerned friend with a link to this meme I was shocked. Shocked that MY photo, a photo of a tender moment, could be used in such a hateful, disparaging way. To see that it was posted 28 weeks ago only makes it worse. All this time MY photo has been circulating with such a hurtful message, a message that I would NEVER propagate. Belittling or negating someone else’s breastfeeding issues or choices is not beneficial for anyone. As mothers we all do what we believe is best for our children. Even though our opinions may differ due to choice or circumstance. I am not a breastfeeding martyr, I have used formula in conjunction with breastfeeding when needed. What was important was that I was able to mother my son in the way I wanted to, due to the SUPPORT I received. Support is something that was lacking in the making of this meme. I do not condone the use of my photo in this way. ~Serena Tremblay


As far as we can tell, the image was originally posted to The Alpha Parent’s Pinterest board “Dear Formula Feeder,” don’t go check it out, it is a virtual collection of putrid hate filled shaming refuse. Nobody needs to see that. There has been no response to our two email attempts requesting the image be removed and destroyed (and never shared again) and so Serena has followed Pinterest guidelines to have the graphic removed. We have tried to utilize respectful means and the proper channels to have this image removed and do believe that Pinterest will not allow the copyright violation to remain. Still, simply having that image erased from Pinterest won’t be enough. It has been seen and discussed in some circles, it’s message cutting and hurting and not helping anyone. The Leaky Boob stands behind Serena that this graphic is not a message we condone. The Leaky Boob, including Serena and all the volunteer admins hold to a very different set of values:

TLB creed

It is rare that I single anybody out for how they run their own website and social media presence. I respect that there are different styles and a variety of people are attracted to those style distinctives. I don’t have to get it or agree. But this has gone too far. Stealing an image and putting words to it that are directly opposed to the intent of the owner of the photo. Standing against the oppression of others is part of my passion for people, so I have raised my voice to express concern and even outrage when I have seen supposed breastfeeding advocates resort to shaming in general and specifically with this same offender. It is not the first time I have vocally opposed messages coming from The Alpha Parent and I agree with Amy West’s assessment of TAP’s “brand” of support. This time though a line has been crossed and while I have long not tolerated any abusive messages in the name of “supporting breastfeeding” within The Leaky Boob community, now I am taking stand against any and all expressions of shaming in the name of breastfeeding advocacy outside of my own little space.

Why am I sharing this with you? What can you do about it? If you’re reading this and have made it this far you probably care at least a little about how babies are fed, the information moms receive, have an interest in parenting support, or at the very least watch online interactions with a passing interest. To those ends then, consider how you are promoting shaming messages targeting others. Here are some simple steps you can take to not contribute to the type of interactions that do nothing to make our world a better place.

  1. Don’t share or spread memes that mock, belittle, or promote the shaming of anyone. This isn’t just a breastfeeding/formula feeding issue. This is a human issue.
  2. Before you use an image, be sure you have permission and don’t create memes and graphics that mock, belittle, or promote the shaming of anyone.
  3. Question every image you see and the message attached with it, particularly online. Everything may not be what it seems.
  4. If you “like” or follow any personality that regularly engages in such messaging, unlike and unfollow them. Take away their audience and don’t align yourself with the hate they are communicating.
  5. NEVER share materials, even if they seem supportive, from a source that you can not verify as free of mocking, belittling, or the promotion of shaming. Many of the breastfeeding support and education sources I follow share materials from The Alpha Parent because some of her content, particularly her older stuff, is pretty decent. Every time I see one of these resources share content from her I cringe, it’s like leading lambs to the slaughter. I loved her “anatomy of the toddler brain” post from a while back but there is no way I’ll share that with my audience, it would be irresponsible of me to do so. Share responsibly.
  6. Ignore them. It is tempting to take a stand and engage in heated arguments with those that thrive on putting down others, particularly online, but truth be told, ignoring them is far more effective in shutting them up. Don’t engage.
  7. Consistently share and interact with messages that promote true support and eventually the attraction of the fight will fade. Offer supportive support and if you find you are tempted to go on the attack, ask yourself why and what insecurities could be motivating you to do so.

I won’t be linking to The Alpha Parent here but I do encourage you to look through your social media channels and remove The Alpha Parent from your playlist if she is there. My intent is not to shame The Alpha Parent or cause her any harm and I hope that she finds her own happiness that doesn’t depend on a false sense of superiority. I hope we all can.



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