Putting on my militant formula feeder hat for a sec….

I made a promise on the FFF Facebook page to discuss why this article bothered me so much, but after the conversation that ensued on my page after I posted the link, I’m not looking forward to writing this post. You all made some fantastic points and I’ve gone back and forth on what I initially thought was a no-brainer. Which is great, but also makes expressing my concerns far more difficult.

I hope that those of you who have followed this blog for any significant amount of time will agree that I take a (relatively) moderate stance, in general. I feel strongly that the fatal flaw in any debate (the abortion battle is a prime example) is an inability to give an inch, in fear of that fabled mile being Hamburgled as well (speaking of which… whatever happened to the Hamburgler? I miss that guy…). The more “hardline” either side of any debate acts, the less likely that debate can ever result in productive solutions.

Sometimes, though, my emotions get the best of me, and this is one of those cases. Maybe it was because I heard about the article in question through a series of Tweets that posted the link using the headline, “Bottle-Feeding Moms Outraged as NHS Withdraws Free Formula Milk” with zingers like “good on them” and “brilliant!” hanging like NYC subway rat tails on the ends. That probably put me in a bad place to begin with. And then, I read the article, and my blood pressure began to rise.

The story is pretty obvious; the National Health Service has decided to stop providing free formula to babies during the postpartum hospital stay. I’m feeling a bit defeated that I even need to explain why this is a problem, but here goes:

1. This is not a matter of doing away with free formula samples or stopping nurses from “pushing” formula. This is a blanket policy, for the express purpose of encouraging breastfeeding rates. To me, that feels awfully coercive. If NHS had said, “ok, guys, we’re outta cash, and we need to cut corners. Bring your own diapers, wipes and formula to the hospital because we’re not providing it anymore, you bloody leaches,” I’d have no problem. Really. I know it’s only semantics, but semantics matter, especially in the case of infant feeding, an issue which has a disgusting history rife with manipulating women (both to formula feed and breastfeed) for the “good of the nation”. 

2. Going back to that give-an-inch-take-a-mile thing, if I were going to be giving birth in the next 2-5 years, I’d be strapping on my running shoes, because that mile is ominously close to becoming a reality. I do not think it’s hysterical or melodramatic to suggest that policies like this – when implemented by people like the one quoted in the Daily Mail article, which I will address momentarily – could quickly lead to other punitive measures, like forbidding women to use epidurals or other pain meds since they lead to lower breastfeeding rates. After all, that’s what the studies suggest, and “baby friendly” policies are based on the same types of studies. 

3. I would lean towards believing that it may actually be a good thing for parents to have to bring their own formula to the hospital – it would stop people from assuming that its the evil maternity nurses who forcefeed formula to innocent babes, and also let parents be informed consumers rather than getting “hooked” on whatever (expensive) formula the hospital doles out (typically freebies given to them by formula companies in order to gain customers). But as I said on Facebook, what happens to the woman who goes in to the hospital assuming she wants to breastfeed, and has a change of heart for some emotional or physical reason once she’s faced with the reality of what nursing entails? I want to ensure that she doesn’t become the victim of some anti-formula agenda. So while I am not opposed to taking away free formula from hospitals on a practical level, I am violently against it on an emotional one. I’m scared to death of what it represents and cannot see it as anything less than anti-woman, anti-parent, anti-freedom and anti-choice.

Okay, so, that’s where I stand on the general issue of refusing to provide women with formula. Now onto the article itself, which is a real humdinger. Someone on Facebook pointed out that the Daily Mail is a bit of a trash publication, and if this is true, I suppose I shouldn’t take it seriously. But I think we’ve seen enough evidence that tabloid or not, these things have a way of leaking in to the general discourse surrounding formula feeding…. so we need to take them somewhat seriously, regardless of the source.

I have selected my favorite snippets, for your reading pleasure – phrases of note are highlighted:

An NHS Trust has sparked outrage by revealing plans to stop supplying free milk to new-born babies…Under the controversial new policy new mothers will be expected to bring their own formula milk, or send a family member to a shop to buy some, if they are unable or unwilling to breastfeed…maternity staff will now have only a ‘small emergency stock’ and mothers who insist on bottle feeding their babies will have access to just one bottle after giving birth…

Notice the language – mothers who insist on bottle feeding.  I haven’t seen much “outrage” sparked over these policies thus far, but I would bet my life savings that there would be rioting in the streets if thesame phrasing had been used in the reverse: “Mothers who insist on breastfeeding their babies…”

Liz Mason, infant feeding coordinator at the trust, said mothers who do use formula will receive advice and support to prevent them overfeeding..She said babies who are bottle-fed formula milk gain weight too rapidly in their first year of life – putting them at risk of obesity and potentially developing childhood diabetes…

I am hoping against hope that Ms. Mason was misquoted; she may well have been considering the highlighted bit is not in quotations, implying that it is not, word for word, specifically what she said. But again, these memes spread quickly, and we already have been fighting an uphill battle getting folks to realize that the obesity/formula thing is a bunch of correlation-not-causation hooey. And by saying that babies who are fed formula gain weight, rather than something like “may gain weight” or “some formula fed babies” confuses the issue further. Not all formula fed babies gain weight too quickly. Not by a loooooooooooooooooooooooooooooooooooooooooooooooooooooong shot.

A price list for baby milk at a local supermarket, as well as opening times, is also fixed to the wall in the day room at the women and children’s hospital…’Bringing two or three cartons in to the hospital with them is relatively inexpensive.’… She added: ‘They have already made that commitment to bottle feed and it will cost them more than £600 in the first year.

….’By offering improved education and support for the mothers who have chosen to bottle feed, it will help reduce the risk of their baby gaining too much weight too quickly and putting the child at risk of becoming overweight or clinically obese…Mothers will be shown how to hold their baby closely and how to safely feed their baby with a bottle.’

Oh, holy hell. Here I was, about to applaud NHS for doing something slightly helpful, and their spokesperson has to ruin it with snark. Veiled snark, but snark all the same. In both these passages, Ms. Mason ruins any guise of trying to support formula fed babies and their parents. Why is it assumed that parents who formula feed will not know to hold their babies close while they do it? And notice I said parents. What about the damn dads? Bottle feeding allows for true co-parenting, so why not embrace that fact and help the dads learn to be more nurturing? And is it really necessary to teach parents not to overfeed in order to “help reduce the risk of…the child becoming overweight or clinically obese?” I might concede that point, if the whole shebang wasn’t based on one recent study that suggested babies who gain weight too quickly will become obese later in life, rather than definitive evidence. Instead, I just find it insulting.  

Real support for formula feeders would be a no-questions asked policy for all parents, allowing them to choose to feed their babies how they see fit, and providing non-judgmental support for everyone. Maybe some instruction on proper mixing techniques. Or level the playing field a bit, and let all parents know that gaining weight too fast isn’t good; that it’s not necessary for babies to nurse or bottle feed every time they cry… although I’m still firmly of the mind that you really can’t overfeed a newborn. They spit up whatever extraneous food you give them. As someone who has both over- and underfed (the first due to comfort feeding and the second because I was overly paranoid about comfort feeding) her bottle fed babies, I speak from experience. You know what would help? A real guideline on how much a baby should be eating depending on age and weight. An explanation about growth spurts. Maybe some education about what hunger looks like in an infant (the rooting reflex is the same, bottle and breastfed babies alike).

So, I’m not convinced that this policy will truly “support” or educate parents. Rather, I think it is one more way for the powers that be to shame women into breastfeeding, instead of focusing on better assistance for those that want to breastfeed. The fact that it is couched in a lame attempt to help the “unwashed masses” makes it all the more disgusting.

I know many of you disagree with me on this, and I totally respect that. But on top of trying to be moderate, I also try to be honest. I would love to stay safely in the middle ground and not veer into the same type of zealotry I rage against, but fear makes me emotional. And policies like this, described by articles like this?

They scare me.

Middle America speaks out…

I’m kind of embarrassed to admit it, but I used to be a TheBump.com addict. I had a rough time conceiving Fearless Child, and their Pregnancy Loss chat room was a lifesaver, offering support when I had none. Eventually, though, the girls I’d grown close with on this board decided to break from the coroporate wedding/baby/domesticity giant and start our own private message board; I haven’t given much thought or attention to Bumping lately.

But now, the Bump is celebrating Breastfeeding Awareness Month in their trademark style (read: glossy, dumbed-down, vague and dismissive), complete with celebrity “breastfeeding stories” and a survey of “thousands” of Bump readers regarding their attitudes towards infant feeding.

Surprisingly, I actually think their survey is interesting and worthwhile. Mostly because of the demographics involved. To be clear, I could not find any detailed demographic info for the site, other than the obvious (American women between the ages of 25-35, mostly college educated and married). After spending every waking moment for approximately 18 months logged onto the site, though, I feel I have a decent understanding of the people who frequent TheBump. Most folks I encountered in my online sojourns were white, middle-income, and from the heartland. The local boards with the least amount of activity were for places like Los Angeles and New York City (although NYC still had a much better representation than LA). So while this is hardly a scholarly analysis, I think it’s a fair assumption to say that any survey of Bump members will reflect middle-class, middle America pretty disproportionately.

This latest poll on breastfeeding is being used, as you might expect, to support assertions that we need more breastfeeding awareness in our country. And on certain levels, I agree with this assessment. For example, this little tidbit:

But what really shocked us? Despite being considered so natural and beneficial, breastfeeding anywhere but home still makes some mamas think twice. Not only did 40% of new moms say they would only do it in public if absolutely necessary, but 23% refuse to do it at all! What’s more, 20% of non-moms answered “Eww, in private please!” when asked what they thought of public breastfeeding. Which begs the question: How can something most of us see as so “natural” still be considered so taboo and uncomfortable – especially by other women?

This is troubling, especially when you consider another finding from this survey – “79% of women polled felt that breast milk is healthiest for baby, while 19% believe formula to be just as healthy.” In other words, we have a vast majority of women who believe in the superiority of breastmilk, and yet a significant portion of them don’t feel comfortable nursing in public. I’m not as surprised by that 20% of non-moms who think like 12-year-old boys, because I actually believe (and feel quite saddened by this) that women are often the worst culprits of making NIP (chat room code for “nursing in public”) difficult for their breastfeeding sisters. I’m not sure why this is; I assume it has a lot to do with our puritanical society and general queasiness about bodily functions. (many of the non-moms I know also get pretty squeamish about childbirth; I’ll admit that in my twenties, when a coworker had a baby and was talking about delivering the placenta and waiting for her newborn son’s belly-button to “fall off”, I had to immediately stop eating my Panera veggie sandwich for fear of projectile vomiting. Now, of course, I can converse about baby poop and egg white cervical mucous like a champ. Things change.) But for nursing moms to feel this way? It’s awfully disturbing, because that implies, at least to me, that these women could easily feel housebound or trapped by their inability to do the necessary work of feeding their babies outside of their own homes. Which is why I will gladly fight for a woman’s right to nurse in public and receive RESPECT for doing so.

But I digress. What bothers me about the interpretation I’ve seen of this survey online is that I think it’s missing the forest for the trees. I read one blog outlining the horror of this finding:

46% of women polled (and 54% of moms) think breastfeeding moms are pressured to wean before they’d like to.

The blog in question railed against a system that would make these women feel like they had to wean early. Which I will agree is pretty messed up. But here’s where reading the result a bit more critically would have helped: the survey didn’t ask mothers if they felt that THEY were pressured to wean early. It simply states that 46% of the women polled (including non-nursing moms, currently nursing moms, non-mothers, etc) THINK that breastfeeding women are pressured to wean before they wanted to. This is a huge distinction, and to ignore it is either poor reading comprehension or a conscious desire to reframe the story.

One last interesting finding, one which none of the blogging pundits mentioned, far as I know: “56% of first-time moms reported trouble BFing and 41% still had issues with Baby #2 and beyond.” I suppose booby traps could be blamed for some of these, but 76% of these women with trouble also mentioned they’d had “help from a lactation consultant or coach in the hospital”, so at least some support is being made available to the majority of moms. I think one could argue that if more than half of first time moms had trouble nursing, 76% of those whose problems started in the hospital (hence, within the first few days), it’s sufficient evidence to reconsider the assumption that breastfeeding is “easy” or “natural”, at least in the environment we are currently living in. Again, I don’t see admitting this as being anti-breastfeeding, but rather an important step in providing the right support for those who want to nurse and who may very likely encounter problems.

Aside from the survey, the Bump decides to post 10 reasons for breastfeeding, which they oh-so-cutely entitle “10 Reasons Breastfeeding Doesn’t Suck”. They state these as facts, with no citations or links, and make a myriad of misleading statements likeIt saves lives — and government money!
If just 90% of US mamas breastfed exclusively for 6 months, not only would an estimated 900 babies live, but the United States would save $13 billion per year. (Yep, $13 BILLION.)” 

…And there we have it: reason #1 why complex methodologies like Bartick’s can be dangerous. The results of studies like hers have a way of creeping into pop culture, in the hands of those who don’t have the education or sensitivity to explain their true meaning.

But hey. It’s the Bump. Who’s gonna listen to the Bump, right? Not like it’s one of the biggest baby-related websites in the world or anything, and considered gospel by thousands of new and expecting moms… nothing to worry about at all. Back to your Saturday evenings, FFFs. Have a drink for me. I could really use one right now.

Haiti Formula Debate Update: Unicef’s Misleading Omission

I stumbled upon this article from Unicef today, which quotes the Haitian Minister of Health, Alex Larsen, regarding the importance of breastfeeding. To reiterate, I am a strong believer that breastfeeding is certainly the safest option for Haitian infants right now, IF at all possible. But I also feel that this has become an anti-formula crusade; that certain organizations are ignoring the reality of the situation (that there are many orphans, or displaced children whose mothers are unavailable or unable to nurse due to injury, etc) and urging people not to send formula, like this will “force” women to nurse since there is no other option. 
In light of these suspicions, I read the following section of the Unicef release with particular interest:

The Ministry of Health recently issued a warning about misleading information that breastfeeding women who have undergone a stressful or traumatic experience cannot safely nurse their infants.

“I want this message to reach all mothers of young children in Haiti: Please, keep breastfeeding. It may save your baby’s life,” stated the Minister of Health, Dr. Alex Larsen. “And for those beyond our borders who want to help, thank you very much for your kindness, but please understand that sending powdered infant formula is not what we need.”

Added UNICEF Nutrition Specialist Mija Ververs: “Protecting, promoting and supporting the best possible feeding practices, with an emphasis on breastfeeding of all infants under one year, is of the highest priority.”

Notice the quote in bold. At first glance, I thought, “Ok… I guess I was wrong on this one. Maybe there really is no need for formula donations. Otherwise why would the Minister of Health say that?

But then, of course, my FFF radar started beeping.

I googled around a bit, and came across a press release (from Nutrition Haiti) referencing Larsen’s 1/31/10 press conference, and found the same quote, with one key difference (in italics):

Quote from Minister of Health, Dr Alex Larsen: “I want this message to reach all mothers of young children in Haiti — Please, keep breastfeeding. It may save your baby’s life. And for those beyond our borders who want to help, thank you very much for your kindness, but please understand that sending powdered infant formula is not what we need. For infants who cannot be breastfed, ready-to-use infant formula is best.”

Interesting omission, Unicef.

The press release has some other pertinent info, like the following:

It is important that mothers know that bottle feeding is not recommended, and instead cup feeding should actively be promoted. Special cups are not needed for feeding infants. In addition, the use of donor breast milk is currently not an option, as it needs constantly refrigeration. However, in a later phase, when specific logistical support is in place and cultural acceptability is tested, this strategy could be re-considered.

I won’t be surprised if someone grabs a soundbite from these statements using just the first sentence…”It is important that mothers know that bottle feeding is not recommended.” Imagine how that would go over. Of course, in context, this sentence means something dramatically different. They aren’t making a judgment call on bottle feeding as we in the US define it – they are talking about the method of delivery for infant feeding. Use a cup rather than a bottle, IF you are unable to breastfeed. That’s all. But it could so easily be misconstrued.

This is a valuable lesson in the power of spin. Unicef has a specific agenda, and spun the truth in a way that is not factually incorrect, but still does not tell the entire story. And it happens a great deal. Just be aware, guys – as my grandmother often said, it’s always good to “consider the source”.

Wouldn’t it be great if everyone could just admit his or her bias up front, like in bold letters on the bottom of every website, paper or study? I’ll even go first!

Disclaimer: As the “Fearless Formula Feeder”, I am sure that my “spin” will always veer in a certain, pro-formula feeding direction, because I am a human, biased mother who had an awful time breastfeeding, with a kid who couldn’t nurse or tolerate breastmilk, and who ultimately thrived on formula. I also admit to a certain agenda (making sure that women get all the facts; protecting our rights as parents; making sure that formula feeding is not so villianized that science can’t continue to improve on products for women who can’t or don’t want to nurse). I freely admit these things and strive to not let them get the best of me.

Anyone want to join in the fun? It’s rather freeing, actually. Unicef? You with me?

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