Category Archives: breastfeeding pressure

Breastfeeding pressure doesn’t care about privilege

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I am privileged.

I’m not rich, but I have never gone hungry; never been without a roof over my head; never wanted for anything (well, nothing more pressing than a better body and maybe a date with Ewan MacGregor circa Trainspotting). I don’t know how it feels to be judged by the color of my skin. I’ve been discriminated against, as a Jew and a woman; called names like kyke and jewbeggar and bitch, but I’ve never been racially profiled or held back by a language barrier, or assumed to be suspicious or uneducated because of the way I look.  I have a great husband and amazing friends and ridiculously supportive parents and in laws.

I realize that in the United States, this means I am incredibly lucky. I also realize that this means I have no business assuming things about anyone else’s lived experience. It doesn’t matter how many academic texts I read or people I speak with in a clinical setting – I can’t know how it feels to be dependent on welfare, or in an abusive relationship, or at a dead-end job with a sexually harassing boss.

I often hear that the pressure to breastfeed is a problem plaguing a specific socioeconomic and geographical subset of women; that my assumption that women are being harmed by overzealous breastfeeding promotion is dripping with “privilege-laden assumptions”. The people making these claims insist that poor, minority women think formula is superior (because they’ve all been victims of unscrupulous marketing and social pressure), and do not know the benefits of breastfeeding, and that if anything they feel ostracized if they breastfeed. Formula feeding, they say, is the unfortunate norm – my concerns have no place in these communities.

I don’t deny that I am coming from a certain perspective, and I always acknowledge that things are different depending on where you live, and what your social circles are doing. I also don’t deny that these social and marketing influences are real. But I think it’s just as privileged to assume that all women in lower socioeconomic areas need to be “educated”, and to ignore the fact that the lower a woman’s status in society, the easier it is for her bodily autonomy or emotional well-being to be violated. Ensuring that the rights of these women are protected is more important than raising breastfeeding rates – and the same policies which are worrisome for a privileged white woman are even more deleterious for someone whose voice is already struggling to be heard.

Yesterday morning, I met with two women who work at an organization serving a lower income neighborhood of Manhattan, helping teenage mothers from a variety of cultural backgrounds. These women told me that in some of the ethnic groups they serve, breastfeeding is very much the norm; in others, it is not as culturally accepted. Their organization is extremely pro-breastfeeding – there is no formula available at their office to give to girls in need, and they encourage breastfeeding throughout the prenatal period and beyond. But when I brought up the idea that the girls these women work with are not being affected by the “breastfeeding makes good mothers” philosophy, I was met with disbelief. “The ivory tower ideal is even more of an ideal for someone who is already struggling to fit the definition of a good mother,” one of them explained. They expressed a need for better messaging – encouraging at-risk women to focus on mothering rather than just feeding. Things like promoting skin-to-skin, reading to your baby, eye contact… not putting the emphasis on breastfeeding as the be-all end-all of parenting.

I also learned that the breastfeeding education these girls are given mostly consists of comparisons between formula and breastmilk, and information on how breastfeeding leads to better bonding and healthier kids. There is little instruction on the actual mechanics of breastfeeding, or how to manage the lifestyle barriers that could make exclusive nursing difficult. So while these young women may go into labor wanting very badly to give their babies the best (and they are well aware its the best, as their prenatal education features lectures on the differences between formula fed and breastfed babies), once they leave the maternity ward and have to return to work or school within a few weeks, without successfully establishing breastfeeding, or knowing how to pump, or how to advocate for their right to express in the workplace (if their workplace even falls under the parameters of the latest breastfeeding laws, many end up on formula- without any advice on how to do so safely.

After that meeting, I had lunch with an FFF who lives in Brooklyn. Her story was all too familiar – wanting to breastfeed, finding herself faced with low supply, getting conflicting advice from healthcare providers, balancing her own health and sanity with her (incredibly nuanced) understanding of breastfeeding’s benefits. The same sort of story we often see on this blog, from an educated mom with a supportive partner who had the ability to hire lactation consultants, and knew how to read scientific literature well enough to suss out her own risk/benefit analysis.

Obviously, this woman came from a very different situation than the women represented in the day’s earlier conversation.  But there was a remarkable similarity in what was expressed by everyone I spoke to. There was consensus on what we need: a more balanced, less hysterical, more individualized approach to infant feeding. All agreed that an honest discussion of the challenges of breastfeeding would be helpful, and that education on formula feeding safely and knowledgeably would go a long way in protecting the physical health of babies and the emotional health of mothers, regardless of their socioeconomic or ethnic background.

The stories these women are telling are not about white or black, native or immigrant, poor or rich. This isn’t about politics. It’s about what will be the best choice for an individual woman in her individual circumstances. These are stories with one moral: that we can – we must – support a woman’s right to breastfeed as well as her right to choose not to breastfeed.  This isn’t about doing away with Baby Friendly, because we need to ensure that women are getting a good start to breastfeeding and every opportunity to make it work (and that means switching the focus from vilifying formula to actually helping women initiate and sustain breastfeeding in practical ways). But we need to speak up and insist that there is a way to do this without loading more pressure onto new mothers.

I have a feeling breastfeeding guilt is seen as a problem of the privileged, because we are the ones with the time, resources, and autonomy to speak up about it. That doesn’t mean women of other backgrounds aren’t feeling the same pressure, perhaps manifesting in even more damaging ways. Still, it’s not my place to pretend to understand them, or to put words in their mouths. There’s no way I could, because these women aren’t an aggregate. They are individuals. To speak for the “disenfranchised” or “minority communities” as a sole entity is asinine. My experience is extremely different from other moms in middle-class Los Angeles – that doesn’t make it any less real, or valid.

One-size-fits-all infant feeding policies do not work, because women are not one-size-fits-all. In fact, in both fashion and life, one size usually just fits a lucky few. To label breastfeeding guilt as solely an experience of one type of woman, and paternalistic “education” as necessary for another, is just plain wrong.  It would be nice, instead of arguing about who has the most altruistic motives to help certain groups of moms feel empowered, we just focused on empowering all women to make choices that feel right for them, and to decide how their bodies are utilized.  Because while I would never attempt to speak for anyone, I don’t think it’s a privileged assumption that most of us would appreciate the ability to speak for ourselves.

 

 

Can formula feeding really be “fearless”?

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The lovely KJ Dell’Antonia recently mentioned my book and blog in a Motherlode column she wrote about the recent onslaught of breastfeeding-pressure backlash. There was the refreshing -albeit unfortunately titled- piece by a father in the Atlantic, followed by another excellent Motherlode post by writer Marie C. Baca about “embracing” bottle feeding- these came on the heels of a number of other articles which cropped up over the summer and in the early fall, as a result of Latch On NYC and a few other initiatives that have passed in the United States and abroad. Dell’Antonia observed that in all of these writers’ submissions (including yours truly’s) to the infant feeding discourse, one thing remained consistent:

…What’s striking about Ms. Barston’s and Mr. Kornelis’s stories, and most stories of “fearless formula feeding” is still really how “fearless” they aren’t. In every narrative of not breastfeeding, there is the obligatory note of failure, as though justification were the first order of the day… for most women, not nursing, for whatever reason, remains a troubling topic. As long as women are occupied with the litany of excuses… then the conversation will stay on defending the bottle or breast, and off the more important question of how to ensure that the choice between them is dictated more by health and happiness and less by circumstance.

This struck a nerve with me. Scratch that – it pinched a nerve. Her theory was like a constant, nagging backache, reminding me that it needed attention every time I moved a bit too fast. It took me a few days to untangle what bothered me so much about these assertions; the ensuing discussion on the FFF Facebook page only served to deepen my desire for answers (or a good massage).

All of you made fantastic points about why we so often appear to be defensive about our choices. Some argued that while we may indeed give excuses, this is because we are conditioned to expect judgment. “I think our stories are tinged with defensiveness since before even sharing them we are already preparing to be attacked,” Tara mused. Lisa echoed that sentiment. “For me, it wasn’t inner guilt – it was everyone’s expectation that I SHOULD feel guilty and that I had done something wrong. Frankly, I was outright pissed off by the insinuations and outright accusations that by formula feeding my daughter, I was setting her up to be fat, stupid, and unhealthy. That’s where my defensiveness came from – the need to defend my choice.” And others thoughtfully mentioned that while we may indeed appear defensive, a lot of it may simply be our way of dealing with complex emotions over the inability to do something we wanted very badly to do:   “”I don’t believe that guilt is a simple emotion – I felt guilty because my boobs failed, I also felt guilty that I was happy that formula was working for us. I felt I was letting my daughter and others down. Guilt is often the result of being unable to change a moment in time – it’s not always about what is right or wrong,” wrote Allison.

As a few of you rightly pointed out, so much comes down to perspective. Unless you have lived through this particular kind of hell, you just can’t understand it. As Misty explained. “I think they mistake bitterness with defensiveness. Unless you’ve suffered the same societal and personal condemnation and guilt tripping that comes with the breast v bottle war, you can’t imagine what kind of damage and pain it causes to a woman’s soul. Obviously, not every woman who tried to nurse but went to formula experiences anguish about it, but many of us do, especially those who had fully embraced the ‘breast is best’ mantra. I still struggle with resentment toward the BFing friends and professionals who, in my opinion, needlessly caused me to suffer terribly as a new mother. I still have sorrow that my first year as a mother was so joyless, because others chose to reinforce my flawed views about BFing (which I’d gotten from them) instead of guiding me compassionately to a more balanced and emotionally healthier way of feeding my child.”

Perspective also plays into the issue of defensiveness in another way: the further away from it you are, the easier it is to approach the “Why I Formula Fed” question dispassionately. I guarantee that for most new mothers, ten years from now- hell, even five – this debate will bore the hell out of them. Other issues will take its place – education, bullying, puberty, safety concerns, etc. However, there are those of us for whom this isn’t just a personal tragedy, but a social problem, a cause which deserves our anger and outrage and yes, defensiveness. I don’t think it’s entirely realistic to hope that we can move away from defensiveness completely, because we are typically reacting to offensiveness.

I think you can be fearless and simultaneously feel the need to defend yourself. All “fearless” formula feeding means to me is that you feel you have made the best choice for your family, for your baby, for you. Fearless doesn’t necessarily mean regret-less, guilt-less, anger-less, resentful-less. It just means you’re not scared of your choice, because you know it is safe, and you know it was right.

But as for what KJ refers to as the “litany of excuses”… I’ve always suspected these are a necessary tool, a ticket to participate in the conversation. By explaining how much you wanted to nurse, and talking about all the struggle you went through to do it, it might help the opposition understand that this is not a matter of lack of education or drive. That it would at least start us on a level playing field, and take down the barricades at the border – I wanted to nurse, you wanted to nurse, we both believe in breastfeeding, so let’s try and discuss this rationally. I have nothing but admiration for women gutsy enough to just come out and say nursing wasn’t for them – I loved Amy Sullivan’s essay in The New Republic, and it was, indeed, the most “fearless” argument for bottle feeding I’ve seen (interestingly, Dell’Antonia felt that Baca’s piece was free from the normal guilt-ridden excuses. I thought it was an excellent piece, on every level – I mean really, really excellent, and quite fearless in a number of important ways – but the fact remains that Baca still mentioned that that she was physically unable to nurse. That gives her a “pass”, in many people’s estimation; it’s still a preemptive strike against condemnation, unconscious as it may have been). But one look at the comment section of Sullivan’s editorial, and you’ll see that it immediately erupted into a hate-fest. Breastfeeding moms took her words as an affront to their method of feeding; breastfeeding advocates told her she was misinformed; judgmental sanctimommies hurled accusations of the usual flavors- Sullivan was selfish, shouldn’t have had kids, etc.

Still, in the past few months, I’ve noticed something: no matter what the writer says, in every online piece I’ve read about formula feeding, the response thread is Exactly. The. Same. The same arguments, the same people, the same facts and studies and name-calling. So while I think we have a right to our emotions – whether these emotions are guilt or regret or anger or pride- we shouldn’t feel the need to state our case in order to create a more peaceful discourse. No matter what you tell them, haters are gonna hate, or whatever that saying is.

Ultimately, I think KJ is right: I’m not sure we can move forward in creating positive change for anyone until we can stop the vicious cycle of guilt-defensiveness-bitterness. I would argue, though, that this is not the responsibility of the women (or men) sharing their stories, but rather that the conversation at large needs to change focus and tone. This might start with media outlets allowing for more nuanced, balanced features on why breastfeeding isn’t working for so many women, rather than coping out with opinion pieces. It might continue with physicians being able to speak out against some of the newest breastfeeding promotion endeavors without risking their careers to do so. It might end with us accepting that changing our society to be more breastfeeding-friendly is far less of a public health issue than it is a question of personal freedom, women’s rights, and trusting our own instincts over what the experts deem is best.

 

 

FFF Friday: “What is wrong with women making choices that enhance their happiness?”

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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.

In light of recent current events, this FFF Friday post from Ellie reaffirms a few key facts:
 
1. Women who choose not to breastfeed for non-medical reasons are not necessarily naive or ill-informed, and have often made carefully-weighed decisions based on extensive soul-searching and research
 
2. The guilt and pressure related to breastfeeding is not simply a side-effect of the ongoing mommy wars, but is also coming from the intense focus on breastfeeding that has permeated the medical community.
 
3. We must be careful not to over-simplify the relationship between sexuality and breasts, nor should we forget that pragmatism has a place in motherhood. 
 
Oh, and one more thing the following post illustrates: the FFF community is made up of some of the most honest, intelligent, and insightful people I’ve ever encountered, both online and in real life. You all make me feel incredibly lucky to have the opportunity to “know” you.
 
Happy Friday, fearless ones,
 
The FFF

Ellie’s Story

In my uber-crunchy city, meeting a highly educated, liberal, mid-thirties mother who doesn’t even try to breastfeed is probably as rare as a unicorn-sighting. Call me a unicorn then, because I planned to formula feed from the start. Part of it was logistical: I have an at-will contract job with no guarantee of not being fired for taking leave, so I only felt comfortable taking 6 weeks (unpaid) leave. My office doesn’t have a pump room and again, no job protection or employee rights for me, so I’d need to formula feed from 6 weeks on. It seemed silly to start for only 6 weeks, then deal with up to 2 weeks of milk coming in for so little actual breast feeding.

Plus, my husband and I were committed to being equal parents. While that’s possible with breastfeeding,  there’s so much momentum created in the beginning of a child’s life. We didn’t want to establish a pattern in which only I can address our kid’s needs.

My other reason was much more personal: after two miscarriages, I’d been pregnant/maybe preggo for a year and a half. I was tired: of not getting a drink with friends, of caffeine deprivation, of curtailing my food choices, of exhaustion, pain, and carrying around extra weight. I wanted my body back. With a high risk pregnancy with some hints of IUGR and other problems,  I also felt, in some fundamental way, that my body just wasn’t up to the task of providing for this baby. I was incredibly relieved that he made it out safely and formula would take away the anxiety that my body was a risky, insufficient source for  my child.

My breasts are also pretty integral to my own sexuality. The cognitive dissonance of “breasts=food! No, wait: breasts=sexy-time!” plus potential pain, lack of libido and persistent numbness after breastfeeding scared me. It angered me when breastfeeding advocates insulted women scared of ruining their breasts or sex lives as dupes who see breasts as solely for men. My feelings were about my own relationship with sexuality, and has little to do with my partner’s.

My choice was cemented after hearing so many other women’s experiences. Despite the propaganda that almost all women can breastfeed successfully, in my survey of six recentish moms, two couldn’t breastfeed for physical reasons, one hated it, and one had such substantial difficulties with it that her first months were a living hell. The two people who really enjoyed it were stay-at-home mothers or quit their jobs soon after giving birth. Once I gave birth, the stories just kept pouring in from women who had soldiered through it but hated it or had to cut out most foods from their diet to deal with an allergy, or had to tape tubes to their breasts to convince their kid to latch. I wanted to sidestep those potential problems.

Finally, part of my job is to analyze scientific research with a skeptical eye, so I’d scanned through the reams of poorly constructed studies and found the benefits of breastfeeding to be pretty modest and hazy.  Did it seem like, on average, breastfeeding was better than not? Probably, all else being equal. But was it the kind of decision I would ever be able to pin a specific problem in my kid to? No. I don’t decide to drink alcohol or exercise or avoid cheese or live in a certain area based on flimsy epidemiological data, so why would I make a decision that would end my career for a good long while based on that data?

When all the establishment is giving you the hard sell on something, and yet less than half of women, despite all this cultural pressure, continue after giving it a fair shot, my spider sense tingled and I was skeptical of its claim that breast is universally best.

Plus I learned something very poignantly after two miscarriages: you can second-guess the potential causes all day long, but in the end, it is out of your hands and the science is so fuzzy that you will never know if exercising or drinking that sangria before you got the positive test played a role. Similarly, you will never know whether you kid has asthma or is less smart or has stomach problems because of formula feeding. You just have to live your life as best you can without basing every decision on fear of the worst-case scenario.

So anyways, I decided not to breastfeed. Friends who’d been there were supportive and recognized the difficulties, but the medical establishment laid on the guilt.  My OB tried to pressure me by claiming that I’d get my figure back sooner, that it was cheaper, I’d reduce my risk of breast cancer, and that it was better for baby. At the hospital, I made it clear that I wasn’t breastfeeding. I had an emergency C-section and our baby wound up briefly in the NICU. A lactation consultant came to the room while I still had the shakes to ask about pumping colostrum. When I declined, she looked at me like I was planning to spoon feed my child crack. Every doctor and nurse asked about it, and then gave an “educational” shpiel, as if the only reasons a woman wouldn’t choose to breastfeed were ignorance, a double mastectomy, or being the Wicked Witch of the West. The onslaught finally got to me and I gave breastfeeding a lackluster shot when my milk came in, but he cried and I cried from the pain and it didn’t seem like he got much milk, so I didn’t bother again. My nipples were scabbed and numb for a few weeks after that one experience.

My little one is still pretty young, just six weeks old, but so far he is doing well. Despite that, the breastfeeding guilt machine has  wormed its way into my brain.   Hubby’s family called me a brainwashed American career woman and harlot for not breastfeeding. Baby has acid reflux and gas which might not be as bad if he were breastfed.  When he didn’t smile at 4 weeks, I worried I had made him “stupid” by formula feeding him. And it’s possible the oxytocin released by breast feeding would have alleviated my PPD. The guilt has only made my inadequacy and depression stronger. Plus, it’s hard to join new parent groups when wary of outing myself as a bottle feeder, despite knowing that could help with the PPD. The guilt is really terrible because a) that ship sailed when my milk dried up, so what’s the point of laying it on so thick?, and b) it just makes all the other struggles of new parenthood that much more isolating.

Yet despite that, my husband has been able to do half the feedings and child care, and when he goes on paternity leave, he can feed the munchkin without some sort of crazy juggling routine. The little one has formed a strong bond with his dad already, we’ve both been able to get about 6 to 7 hours of sleep from the get-go, and our sex life is not decimated. It’s also been really amazing to watch my mom and dad be able to feed him. Hopefully as our baby gets older and is fine, my guilt will subside.

In some ways my story may reaffirm the “lazy, careerist, selfish formula feeder” stereotype, but that just highlights the incredibly problematic mentality that surrounds breastfeeding and motherhood in general. What, exactly, is wrong with women making choices that enhance their happiness? What, exactly, is wrong with making choices that make your life a little easier as long as they don’t do real harm to your children?  Our society fetishizes sacrifice for its own sake, and ignores the reality that all parenting decisions are trade-offs between the ideal and reality, between cost and benefit–especially when women bear the brunt of those trade-offs. Studies show that bilingual kids have many cognitive advantages, but we don’t all move to Switzerland!

Breastfeeding is awesome and way easier than formula for many. We should absolutely remove structural barriers to breastfeeding (more workplace protections, support for public breastfeeding, maybe baby friendly workplaces ). But lots of people have reasons for not doing so, and that choice should be considered just as valid as other parenting decisions.

If I had another kid, I would probably give breastfeeding a shot, assuming my job situation was better. There definitely are some conveniences, such as not having to bring or wash a bottle or get formula feeding stains out of clothes. It would be awesome to just roll over at night, pull up my shirt, and feed in my sleep. But even if I did breastfeed, I wouldn’t see it as somehow “doing better” the next time, and if it wasn’t working out, I’d have zero qualms about formula feeding. It would be a personal decision that was best for our family at that time.

 

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Share and share alike! Send me your story – formulafeeders@gmail.com.

Dear Mayor Bloomberg: Please stop the smoke and mirrors

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Dear Mayor Bloomberg,

I’m sure you’re sick to death of hearing about the Latch On NYC initiative. There’s been so many blog posts, opinion pieces, counter-opinion pieces, etc., inspired by the announcement of this policy… I felt it was redundant to add more fuel to the fire, after I said my piece the week the policy was made public. I was hoping to avoid making this personal, as we’re both from the same town (in fact, my mom and you were neighbors growing up) and I always had a soft spot in my heart for the local boy made good.

But unfortunately, your camp has made that an impossibility. Not necessarily because of the policy itself (although I do have many problems with it), but because they have pulled the most transparent, juvenile stunt that essentially begs for caustic commentary.

Back to the policy for a minute: I’m sure you’re aware that it has changed dramatically. So much so that everything I talked about in my prior post now sounds like the rantings of a paranoid moron, with a fondness for extrapolation. And it’s not just me – smart, rational women like Katherine Stone are enduring an onslaught of patronizing op/eds which reduce their concerns over personal autonomy and women’s rights to a “misunderstanding” of the policy.

I have serious concerns about the capabilities of our country’s journalists for not pointing out the giant, defecating elephant in the room: the reason there is a disconnect between what those of us who have raged against the policy wrote, and what is now being written by people sounding far more rational and balanced, is that the literature that was initially published online by your Dept of Health has been erased from existence. In its stead lies a “Myths and Facts” document, a step-by-step dismantling of the concerns brought forth by the initiative’s critics.

The outlining of the plan which made me so hysterical? They literally made it disappear. As in, whoosh, the hat became a rabbit. No public announcement admitting that your administration had overstepped or misjudged; not even an acknowledgment that the policy had been altered or revised. Just one day there, next day not.

Let’s walk through the new “Myths and Facts” document which took the place of the old “FAQ”. Unfortunately, I did not take screen shots of the original – I wish to god I did, but I naively never thought your office would condone such a blatantly disrespectful, Orwellian action. Luckily, a fantastic blogger at a site called Breastfeeding Without BS copied the sections I found most troubling verbatim on her post about the initiative, so we still have access to the text as it originally appeared.

What the new document says:

Myth: The city is requiring hospitals to put formula under lock and key.

Fact: Hospitals are not being required to keep formula under lock and key under the City’s voluntary initiative. Formula will be fully available to any mother who chooses to feed her baby with formula. What the program does is encourage hospitals to end what had long been common practice: putting promotional formula in a mother’s room, or in a baby’s bassinet or in a go-bag – even for breastfeeding mothers who had not requested it.

What the old document said:

What does it mean to restrict access to formula?

Restricting access to formula means storing formula away from where it is easily visible and accessible to staff and mothers. Access to formula is restricted by both:

…Storing formula in a locked location, such as a storage room, cabinet or an automated medication system or, storing formula in a location outside, but reasonably near, the maternity unit……Limiting the number of hospital staff with access to formula by implementing a system to identify which hospital member accessed the formula supply; some examples are a log book, a code or a key system. 

 

Mayor, I’m confused. How is keeping formula in a “locked location”, available to only a “limited number of hospital staff” who should use a “log book, code or a key system”, making formula “fully available to any mother who chooses to feed her baby with formula”? I don’t recall if the original document explicitly stated that hospitals must keep formula locked up or if it was merely suggested, but in either case, I don’t think it’s a stretch to see why this particular “myth” seemed like a scary truth to many of us.

 

What the new document says:

Myth: Mothers who want formula will have to convince a nurse to sign it out by giving a medical reason.

Fact: Mothers can and always will be able to simply ask for formula and receive it free of charge in the hospital – no medical necessity required, no written consent required.

Myth: Mothers requesting formula will be subject to a lecture from the nurse.

Fact: The City’s new initiative does not set a requirement that mothers asking for formula receive a lecture or mandated talk. For the last three years, New York State Law under the Breastfeeding Bill of Rights, has required that mothers simply be provided accurate information on the benefits of breastfeeding. This requirement has not changed under the City’s new initiative.

What the original document said:

What do we tell our staff to do when mothers (families) request infant formula? 

While breastfeeding is healthier for both mothers and babies, staff must respect a mother’s infant feeding choice. Educating mothers and families about breastfeeding and providing encouragement and support, both prenatally and after birth, is the best way to ensure breastfeeding success in your hospital.

While in the hospital your staff can:
Assess if breastfeeding is going well and encourage the mother to keep trying.
Provide education and support to mothers who are experiencing difficulties.
If the mother still insists on receiving formula, document it in the chart along with the  reason and distribute only the amount of formula needed for the feeding.
Train staff in breastfeeding support (CLC, IBCLC) who can be available to assist new mothers at all times regardless of day, night or weekends.

 

Notice the difference in language and tone here. “Mothers can and always will be able to simply ask for formula…no medical reason or written consent needed….” versus ‘Assess if breastfeeding is going well and encourage the mother to keep trying…if the mother still insists on receiving formula, document it in the chart along with the reason and distribute only the amount of formula needed for the feeding.” We’re talking semantics here, but policy is all about semantics – and the “myth” sounds an awful lot like what was written in their initial, official FAQ literature. Obviously it does not state simplistically that moms will have to “convince a nurse” that there is a medical reason, or be “subject to a lecture”, but I don’t think it’s much of a stretch to imagine that this will be what ends up happening when the policy enlists health care providers to “encourage” a mom who has already made a decision – for whatever personal reason – that she wants to supplement; I don’t think it’s overreacting to take umbrage at the terminology “if the mother still insists” or the fact that nurses are told to only give the amount of formula needed for that feeding. As BF without BS so eloquently put it:

But what does “Assess if breastfeeding is going well and encourage the mother to keep trying” actually mean in practice? If the mother says clearly “I don’t want to do this any more,” is the nurse required to keep urging her to continue? Where do you draw the line between support and nagging? The initiative gives us no clear answers. Certainly, the use of the word “insist” here is deeply problematic. My understanding is that a person only “insists” on doing something when they continue to state their need after having experienced a considerable amount of pressure to do the opposite.

 

What the new document says:

Myth: Latch on NYC is taking away and/or jeopardizing a woman’s right to choose how to feed her baby.

Fact: The initiative is designed to support mothers who decide to breastfeed. For those women, the program asks hospital staff to respect the mother’s wishes and refrain from supplementing her baby with formula (unless it becomes medically necessary or the mother changes her mind). It does not restrict the mother’s nursing options in any way – nor does it restrict access to formula for those who want it.

Myth: Formula will be forbidden in some fashion.

Fact: If a mother decides she wants to use formula (or a combination of formula and breastmilk), she will be supported in her decision and her baby will be given formula during the hospital stay. If a breastfeeding mother changes her mind or requests formula at any time, her baby will be given formula.

 

In the original document, considering there is no further instruction given on subsequent requests, I think it was fair fair to assume – or at least to fear – that a lecture and limited formula will be the protocol for each and every feeding. It would have been easy enough for the authors of this document to add “Once it has been established that the mother has made an informed decision to formula feed, she should be given formula without further questioning, upon request” or even better, “a supply of ready-to-feed, pre-sterilized bottles and nipples should be left in her room for feedings.” As a formula feeding mother, that is what  ”not restrict(ing) the mother’s nursing options in any way “ and not “restrict(ing) access to formula for those who want it” means.

 

What the new document says:

Myth: Positive benefits from breastfeeding are being overblown or aren’t true.

Fact: There is overwhelming evidence, supported by national and international health organizations, showing that breastfeeding produces better health outcomes for babies and mothers than formula. For mothers, breastfeeding reduces the risk of breast and ovarian cancers. Babies that are breastfed have a lower risk of ear, respiratory and gastrointestinal infections, as well as childhood asthma, than babies who are formula fed.

The American Academy of Pediatrics just published new guidance to pediatricians in February 2012, reaffirming the evidence that the health benefits of breastfeeding over formula are clear: http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html

What the “Initiative Description” (which is still available – for now – here) says:

Formula feeding markedly increases serious health risks for infants, including:

o 257% excess risk of hospitalization for lower respiratory infection

o 178% excess risk of diarrhea and vomiting o 100% excess risk of acute ear infections

o 67% excess risk of asthma for infants with a family history of asthma (35% for infants with no family history of asthma)

 

Again, the language here is markedly different. The spin doctors who have performed surgery on this document are skilled; I’ll give them that. I don’t think most of us would argue that there have been “better health outcomes” reported for breastfed babies; it’s the inflated representation of the statistics that we found misleading – a “100% excess risk of acute ear infections” sounds like formula fed babies have a 100% greater chance of getting ear infections to the untrained ear, and most of the NY public probably doesn’t have an advanced understanding of statistics.  But that’s almost irrelevant. The more important point here is that neither of these passages addresses the concerns that scholars like Joan Wolf have brought up, or the writers who have used her work to illustrate their essays: concerns like the confusion of correlation and causation, and the inherent flaws in breastfeeding studies, which make these statistics (even in their non-puffed-up form) questionable. Where’s the acknowledgment that even the literature used to support these claims has a clear warning that these very issues need to be addressed?

As I stated in my original post on Latch On NYC, I think it is a positive thing to support breastfeeding by not shoving formula in a mother’s face at the first sign of breastfeeding challenges. I think it’s wonderful to offer more lactation support, and to encourage rooming in, and not insist on formula supplementation unless it is medically indicated.  But this is not  all that Latch On NYC, as initially put forth to the public, is doing. Notice that there has not been the sort of outrage we’ve seen regarding this initiative towards any other Baby Friendly Hospital Initiative in the country. This outrage has come from breastfeeding moms and formula feeding moms alike. It has come from Democrats and Republicans and Independents. It has come from people who don’t even have children, nor plan to. There was a reason for this outrage, and I think it is unspeakably rotten for the mayor’s office to perform this rather amateur feat of smoke and mirrors to make it look like the vast majority that disapprove of this act are either anti-breastfeeding or ignorant.

Mayor Bloomberg, I hope that the scarier aspects of this initiative have been erased along with the document that outlined them. I’d much rather have the expectant mother of NYC be spared from injustices than be “right” about what I feared regarding this policy. But I would implore you to come clean about how this all went down; to allow this initiative to start out on the right foot. It will not help raise breastfeeding rates to have women going into    NYC labor and delivery suites with their cockles up, ready for battle. There are elements of this plan which should be rightly celebrated, and you have essentially rendered that impossible by allowing for such dirty warfare. Those of us who raged against the original plan are not a bunch of uneducated militants who work for the formula companies. We are mothers, daughters, and concerned sisters, some of whom have experienced the sting of breastfeeding “failure” on a personal level, and others who have studied this discourse and its historical relevance at length, and simply feel that there are better ways to support breastfeeding than to frame formula as the enemy. I beg you to sit down with some of us and listen to what we have to say, and at the very least, make the original FAQ PDF reappear. It won’t require magic, just the small bit of courage it takes to admit you were wrong and promise to try better next time. We are all trying to win the same war (better support for new moms, and healthier babies for NYC and the country at large), so let’s not get ourselves caught up in friendly fire…okay?

Best,

Suzanne Barston, FearlessFormulaFeeder.com

 

The more things change, the more they… change.

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I had an interesting conversation the other day with someone who read the galleys of my book.  This woman breastfed two children successfully in the late 80′s and 90′s when this feeding method was certainly not the norm; breastfeeding rates didn’t start really going up until the past decade, when campaigns like the log-rolling, mechanical bull-riding DHHS one began to to kick things into high gear.

Anyway, she had a good experience breastfeeding; she told me she never really experienced much pressure in either direction, and while she was aware that breastfeeding had become far more of an issue in society, she had no clue that formula feeding had become so vilified.  Her exact words were “I had no idea how bad it had gotten.”

I know it sounds ridiculous, but this comment provoked a tremendous revelation for me. Imagine a cartoon image of the FFF (imaginary-draw me with a better figure and less wrinkles, will you?) being hit with a lightening bolt, next to the caption “Doh!“

Of course this person didn’t know how bad it had gotten. She hadn’t given birth in the last 5 years, when the pressure to breastfeed has gotten so ridiculously out of control. And neither have the vast majority of big-time breastfeeding advocates or policy makers, let alone the folks reading the various newspaper editorials and commenting on the heated threads of media-reported breastfeeding studies.

See where I’m going with that “Doh”?

I have had two kids in the past four years, and honestly, I saw a marked difference in the amount of breastfeeding pressure I experienced from one baby to the next. In 2008, it was tough to end up in the formula feeding category; still, most of the vitriol I encountered was the online variety, save for a few  overbearing physicians and mommy-and-me instructors. By the time I delivered Fearlette in the end of 2010, even my childless, motorcycle-driving, gun-wielding neighbor threw me a look when he saw my bottle. And since I have my eyes on what’s happening in the breast/bottle scene, I can say without a doubt that things are just getting worse.  I don’t know if these changes were spurred by Hannah Rosin taking a stand, or Joan Wolf questioning the science, or the Call to Action announced by the US government - but one thing is clear: infant feeding has become part of the national dialogue, and gone far beyond a trivial mommy war.

Mary wore the hairshirt, sans the “F”. Source: Wikipedia.org

If you were a breastfeeding advocate who’d had children before this new front blew in, you might think my pleas for a ceasefire are nonsensical. Kind of like when my mom complains she’s cold on a temperate, 78 degree day. But then again, my mom happens to be super-skinny (like 85 pounds soaking wet), and those without any padding can have issues with temperature regulation. Likewise, women giving birth today have been stripped of the padding when it comes to breastfeeding pressure; no longer are we cushioned by “encouragement” to breastfeed, but rather thrown out onto a cold street with a hairshirt labeled with a big, scarlet “F” should we fail to meet expectations; if we end up being “suboptimal” in our feeding methods.

If you’d been a new parent in a different, not-so-long-ago time, you might think things aren’t so bad. You might brush off feelings like guilt, saying that “no one can make you feel guilty”. That’s easy to say when no one has told a 3-day postpartum You that your inability to breastfeed, or your choice not to, is damning your child to a life of poor health and low intellect. (It’s also easy to say when you’re someone who has never been through this kind of hell, or when you have a penis rather than a vagina and are therefore of the non-lactating persuasion.)

If you’d been a new parent back in, say, the 1970′s or early 80′s, when breastfeeding rates were at an all-time low, it might be easy to laugh at the stories we tell on this blog. Because nobody’s really telling formula feeders they are bad parents. It’s being a breastfeeding mom that’s hard. (Which don’t get me wrong, it can be. I think you’re damned if you do, damned if you don’t, in this regard. But that doesn’t mean formula feeders have it any easier- it’s just that our challenges come in different flavors. My platform is that we can’t protect one group of parents by shaming or neglecting the other – we all need to be supported in feeding our babies in the way that works best for our given situation.)

If you’d been a new parent even ten years ago, when breastfeeding began to be more popular, but three months was considered medically sufficient, and six months was considered ideal, you might not fully comprehend what this breast/bottle debate is all about. You might think hey, it wasn’t so hard to breastfeed, not realizing that by today’s standards, the fact that you stopped after 4 months and had been giving relief bottles every now and then would be considered abject failure by many respected experts.

If you haven’t given birth or adopted an infant since before Obama was in office, and don’t plan to again, you might not care that much about infant feeding “wars”. And that’s okay; I get that many things begin to take on graver meaning, like ensuring a good education (we’re facing that now and I swear I’m *this* close to closing down FFF and starting the Fearless Public School Parent in a Really Awful, Underfunded District blog, but then I remember Sandra Tsing Loh beat me to it), drugs, teen sex, and so forth.

But for the breastfeeding advocates, physicians, psychologists, and media pundits out there, whose voices matter in this discourse: please, for the love of god, take a minute to consider that things may have changed dramatically since you were buying Size 1 diapers. This has nothing to do with the benefits of breastfeeding, nor am I belittling your efforts to make the world friendlier for nursing moms (which I appreciate and thank you for), but it is important that you realize this fact. You need to understand what it is to be a mom in 2012, when the internet has all but usurped the “real” world; when Facebook pages are not just about reconnecting with high school flames but are used to discuss parenting styles and form “groups” which simply exist to hate on other peoples’ choices; when a scathing blog post has the power to change the face of advocacy in a disturbingly negative way; when the media has covered stories which state that women who “fail to comply” with breastfeeding recommendations are costing our country innocent lives and billions of dollars.

I know everyone says the more things change, the more they stay the same. In this case that does not hold true. Things are not the same. The sooner society at large realizes this, the sooner this discussion will begin to evolve.

Or at least I hope it will. If it doesn’t, the silver lining is that I think I’d look pretty cool in a hairshirt.

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