Begging for Balance Before Banning the Bags

Last month, Maryland became the fourth state to eliminate the practice of handing out formula samples at hospitals. This was heralded as an important move in ensuring the health and welfare of the state’s newborns, as these sorts of initiatives always are. Reporters quoted breastfeeding advocates and nurses talking about how hospitals should be “marketing health”:

“This move allows Maryland hospitals to put their smallest patients’ health first,” said Dr. Dana Silver, pediatrician at Sinai Hospital and vice president of the (Maryland Breastfeeding Coalition), said in a statement.

From The Baltimore Sun

While the ban was officially a voluntary decision from the state’s 32 birthing hospitals and not a ruling from the state government, there were an awful lot of comments coming from state officials about the new policy:

“With changes like ‘banning the bags,’ we expect to see more mothers to try to exclusively feed their infants through breast feeding,” said Dr. Howard Haft, deputy secretary of public health services, in a statement. “This provides better overall health outcomes for Marylanders and brings us closer to achieving national goals in this area.”

The move was proposed three years ago by state health officials as part of a package of steps hospitals could voluntarily take to support breast feeding, which studies show may provide health benefits to the infants and mothers

- The Baltimore Sun

Supporters of the “Ban the Bags” movement claim that mothers who get the formula samples are less likely to exclusively breast feed and stop breast feeding before mothers who don’t get the formula.. They are absolutely correct. There are many studies showing this result, and I am in absolute agreement with them that the bags should NEVER be indiscriminately handed out upon hospital discharge.

Further, I agree that there’s no need for any marketing to be allowed in the maternity ward. As long as we all agree that this really means NO MARKETING. That includes free samples of Medela breast pads. I would also argue that posters ‘advertising’ the benefits of breastfeeding – often with slogans that are inherently shame and anxiety-producing – have no place in the maternity ward.

And lastly, there’s a valid argument that allowing formula companies to provide samples drives up the cost of commercial formula. But this is a bit of a straw man, because the marketing budgets of large pharmaceutical corporations are built in well-thought-out, specific ways; I suspect that Enfamil will find a way to use whatever money was going into the hospital discharge packs and spend it elsewhere. The cost of brand-name formula isn’t going down anytime soon, which is why it’s a wonderful thing that we have high-quality generic options on the market.

All of these arguments in favor of the Ban the Bags movement are valid. But there are other, equally valid arguments opposing it, that are being uniformly ignored by those in power:

What if mothers actually want the samples?

What if these samples allow parents to feed their babies the safer but far more expensive ready-to-feed nursettes, which reduce the risk of bacterial infections and exhausted, new-parent errors in preparing powdered formula?

What if the formula-sponsored discharge bags are the only real source of formula “education” parents are receiving?

Granted, these three questions all have other solutions than “give everyone formula samples”. For example,

- Formula samples could be on hand but only given upon parental request.

-These samples could be generic RTF newborn nursettes, pre-measured into small amounts that would prevent overfeeding (since everyone is so concerned about formula-using parents force-feeding their babies until their thimble-sized tummies expand, cursing them to a lifetime of morbid obesity)

-Samples could be outlawed, but all parents could instead receive a pre-discharge tutorial on safe formula feeding, what to look for in terms of insufficient breastfeeding and/or jaundice, and also a pamphlet or book with unbiased, easy to understand instructions for all safe feeding methods (breastfeeding, pumping, donor milk, formula feeding), as well as a local resource list for breastfeeding, formula feeding and postpartum mental health support.

Advocates for Ban the Bags can claim that these policies are put in place to protect babies, rather than to shame mothers or take away their options, but they need to understand that this is indeed the perception. I conducted a simple survey, composed primarily of the Fearless Formula Feeder audience, to explore what formula-using mothers thought of these initiatives. Of course, this is a biased group – most started out breastfeeding and switched to formula within the first 3 months, and some formula fed from the beginning (although I did open the survey up to anyone, and we did have 17% who exclusively breastfed, and 15% who breastfed and switched to formula between 3-12 months). But I’d posit that their bias is what makes their opinions so powerful. These are the moms who didn’t end up exclusively breastfeeding. If they felt that formula samples were at fault for this result, we would see that on the survey. Instead, this is what the survey found:


Hurt your breastfeeding efforts= 2.26%

Help you in some way = 22.56%

Neither= 32.83%

Some of the open-ended responses included:

“I was offered a bag but refused it.”

“It was an absolute blessing- i needed to supplement while my breast milk came in, and it meant that i didn’t have to run to the store while recovering from 2 c-sections.”

“It did not influence my decision to switch to formula after 4 weeks, but it was so helpful to have the formula sample to try and see if it helped before buying expensive formula at the store.”

“Gave it away or threw it out.”

“It helped tremendously. I could only produce enough breastmilk for one baby, but I had two. Formula is expensive (as are babies, and we had two!), so the formula that the hospital sent us home with was invaluable. We wouldn’t have bought the nursettes on our own (we’re too cheap), so the ones that the hospital gave us made the first few weeks of parenthood a little bit easier. We weren’t having to mix formula after not sleeping.”

“I had a stack of breast feeding information given to me, a breast feeding class to attend, and a formula bag with some info and a small can of formula. The bag was just a nice gesture to formula being a choice for me and my babies.”

“I wasn’t as stressed about breast feeding bc I knew I had some formula to use if needed.”

There were some responses suggesting that the formula samples were detrimental to breastfeeding success, supporting my assertion that these should be clearly called Formula Bags, and only given upon request:

“It made me feel like the only option was failure… Here are samples and coupons so you can hand your life over to the formula companies.”

“… I forgot about it and when I found it the formula was expired. It was wasteful.”

“I felt like thenurses had no confidence in my ability to breastfeed. When I was given the bag I felt like I was destined to fail and everyone knew it except for me. My sister helped me to overcome the initial obstacles and I was successful meeting my breastfeeding goals, but without her I’m not sure I would have continued past two weeks.”

For those respondents opposing Ban the Bags, the most common impression was that it shamed formula feeding parents:

Chart_Q5_15110467% of respondents felt that the initiative “shames parents who choose formula”; 60% didn’t like banning the bags because the samples came in handy; 31% said that the bags were “the only source of formula education I received.”

Open-ended responses included:

“Because it’s paternalistic and undermines a parent’s right to choose how to feed her baby”

“I don’t think it should be banned altogether, samples should be available to women who choose to formula feed or combo feed, but I don’t think formula companies should be targetting women who intend to breastfeed exclusively any more than Lansinoh or Medela should target women who intend to formula feed.”

“Because it should not be the government’s business to create a culture of shame around a product that many new parents need. I think it would be fair to educate new parents that supplementing may interfere with their milk supply if they express a desire to breastfeed exclusively. Beyond that, they should leave it up to the parents if they wish to receive them or not. If a company wishes to provide a sample, their client base should be allowed to receive it…the samples are helpful as parents make decisions around what is best to feed their child.”

“Because it implies a qualitative judgement on formula use. Parents have a right to choose their feeding method and the hospital does not have a right to attempt to manipulate that choice. With both of my children, I was offered only pampers brand diapers in the hospital. Why does pampers get the opportunity to push their brand name but not a formula company?”

“Because it is completely, 100% disingenuous and insulting to insinuate that a promotional bag has more power over me than my own well-reasoned decision-making processes.”

“It implies parents aren’t capable of making a choice. That we women are so weak willed that if we see a formula sample we’ll throw our breastfeeding goals away for a few samples. It laughs in the face of informed consent. If one is going to make a choice human milk or formula then they should be given ALL of the information. The only information parents are given at appointments and from the hospital is about breastfeeding. Yet if a formula company gives formula information it’s decided it’s only for marketing. Sure formula makes formula companies money but if the hospital offered unbias formula information about it instead of 10 risk of formula feeding lists we wouldn’t be seeking it from the formula companies.”

“Much like banning condoms & birth control doesn’t prevent sex, banning formula samples & literature doesn’t prevent parents from using formula. It’s dangerous – parents need ALL the info about infant feeding. “Ban the Bags” initiatives are tantamount to sticking your fingers in your ears, closing your eyes, and saying “na na na I can’t hear you it’s not happening.” Childish and completely ineffective.”

The most attractive solutions for most respondents were to hand out the sample bags only upon request (73%), or to give an unbiased book/pamphlet talking about all infant feeding options (62%)  as an alternative:

Chart_Q7_151104(Interestingly, 19% chose “parents could receive sample bags of breastfeeding-related products”. I find this interesting, as it does negate the more palatable argument (at least in terms of feminism and bodily autonomy) that the reason to ban the bags is to take corporate interests/marketing out of healthcare settings. Apparently, predatory marketing on postpartum women is perfectly okay, provided it comes from Lansinoh rather than Similac.)

Many respondents mentioned feeling like the gift bags “normalized” formula, saying that it was the only time formula was mentioned or seen during their hospital stay. For those choosing to formula feed or combo-feed from the start, this can be disheartening. If formula were discussed as an option, without the scare tactics or patronizing language used in most healthcare settings, perhaps getting rid of the bags would meet with less outrage. In a space left for respondent comments, a sense of feeling marginalized and that there was only one “right” choice for infant feeding was clear:

“I had zero information about the right way to formula feed. I had no idea how good formula was good for, how to properly store it, the right amount to give, etc– I only learned from formula containers. Information about this in a pamphlet would have been very helpful.” 

“The lack of free formula is not my concern. I am concerned that regulating this shames formula feeders (i.e., the message is that formula is so awful it should not be given out by a hospital). I am also concerned about the total lack of education in hospitals about when and how to supplement or EFF.”

“ These are often the first times mom and dad are presented with formula, and the only “education” and information they may receive about it. Yet breastfeeding info and help is available in quite a widespread manner. Again to take this away would do a great deal of harm for parents who may exclusively formula feed, as they could certainly use whatever educational info they can get about formula feeding.”

“Parents should be given accurate, and unbiased info about ALL feeding options. Denying info about a healthy, and nutritional feeding choice merely due to zealotry does nothing to help women, or children.”

“Formula information and samples should always be available on request – no questions asked. Also safe and clear information for both feeding methods needs to be made to all parents. Breastfeeding, pumping, bottle feeding, sterilising equipment, post partum depression, maternal health, and safe practice for storing formula and breastmilk.”

Although there’s been a recent backlash against breastfeeding pressure, this is not an issue of questioning breastfeeding’s benefits. Of course hospitals should be protecting and supporting breastfeeding, provided it is something a woman is not opposed to doing, but we also have to be realistic: formula is here to stay. It is going to be used, and the way we’re going about things now, it is going to be used incorrectly, with shame and guilt and fear. Of course direct marketing to patients has no place in the healthcare setting, but in a climate where formula is being kept under lock and key and treated like tobacco or alcohol, we need to be aware that the formula companies are often the only ones discussing their product with new parents. If we truly care about “putting the health of our smallest patients first”, then do exactly that, because leaving their parents without proper info on formula use is putting their heath in danger. Making their mothers feel marginalized simply because their breasts don’t work how they are supposed to, or because they have personal, valid reasons for not wanting to feed a child from a culturally, emotionally-loaded part of the female anatomy, puts the mothers’ health in danger, which can obviously affect infant health as well.

These are not simple issues, so let’s not oversimplify them by insisting that taking away a bag – a bag that can be taken or left, like the jello on the hospital tray – is going to make a huge impact on breastfeeding rates, while ignoring the impact it may have on the experiences of formula-using parents.

Balance before bans. That’s all we ask.






It’s Not About the Brelfie

For obvious reasons, I get excited whenever the media takes notice of how formula feeding parents are feeling.

That’s what happened yesterday, when the media (and my email, Twitter and Facebook feed) exploded with the news of a new campaign meant to fight back against breastfeeding pressure, using the hashtag “#bressure”. When I first read the articles about the movement, I noticed the positive (attention to the experience of “failing” to meet breastfeeding recommendations) and ignored the references to the “brelfies”, breastfeeding photos which apparently spurred the campaign in the first place. I even sent a letter to the creators, praising them and asking if the FFF community could contribute in some way.

But as the day wore on, red flags started popping up. First, a fellow blogger alerted me to the fact that the survey conducted by the Bressure movement alluded to breastfeeding selfies as “sexualized”. Then, every single article I read focused on how these (apparently sexualized) “brelfies” were directly causing pain and suffering to bottle feeders. Instead of talking about the systemic issues that create a cycle of guilt, fear, and competition, we were once again dragging the conversation down into the mommy-war gutter, pitting woman against woman, and continuing the seemingly endless divide between breastfeeding and formula feeding moms.

This is not progress.

I’ve run a modestly large international community of formula feeding parents for the past six years, and I know several truths:

1. Formula feeders are a diverse group, just as breastfeeders are a diverse group. There are militant, intolerant formula feeding parents who truly do believe that women shouldn’t breastfeed in public, just as there are militant, intolerant breastfeeding mothers who believe formula feeders are selfish, ignorant, and useless. I wish we could vote them all off the island, but alas, such is life. The problem is that we’re letting these factions monopolize the conversation. This is EXACTLY why we started #ISupportYou, to which there was a rather vocal backlash from the intolerant/militant faction, on both sides.

2. The media loves drama. It is so much more fun to blame “brelfies” for the pain we formula feeders endure, because then the extremists come out of the woodwork and create mile-long comment sections, boosting your traffic for the next few days. It is also easier to get inflammatory quotes when nuance is ignored. Nuance doesn’t get web traffic or media attention. Trust me on that one; I speak from experience.

3. Seeing breastfeeding photos is undeniably difficult for those of us who wanted to breastfeed and couldn’t, or feel conflicted about our choices. When we’re feeling vulnerable and judged, it can definitely feel like that model/celeb/Facebook friend’s breastfeeding selfie is intentionally meant to twist the knife a little deeper. But that shouldn’t stop a mom from posting a breastfeeding photo, any more than you should refrain from posting a shot of your newborn when your second cousin is struggling with fertility issues. Both of you have the right to your feelings – your pride, her grief. (That said, there’s the social media-era problem with all of us comparing ourselves to others, posting things we’d never say to someone’s face, and basically acting like insensitive jerks every time we hit “post”.)

4. The breastfeeding selfies themselves are not the problem, but the  ”#breastisbest #breastfeedingmomsrule #whatsyoursuperpower hashtags can be construed as an attack on formula feeding moms. That’s not me telling you to stop doing them, just explaining why the photos might hurt your best friend who switched to formula three weeks ago. That is not me telling you that the cause of normalizing breastfeeding isn’t important, just explaining why there might be better ways to achieve the same goals without adding to the conflict. Just like this latest “bressure” video series could have had a hugely positive impact, if the impetus behind it didn’t sound like bitterness and jealousy and a who-has-it-worse competition.

5. There’s enough anger, misunderstanding, and generalization on both sides of this debate to fill several football stadiums. When the media chooses to focus on something trivial (“brelfies” – for the love of god, who though of that term) instead of the real issues, we all lose. Personally, it makes me feel like I might as well jump in my DeLorean and head back to 2008, because what the hell have I wasted the past 6 years of my life on?

6. The top reasons that formula feeders are angry, based on my totally unscientific, not-peer-reviewed but at least peer-collected research, are the following:

We are made to feel like inferior mothers by medical professionals, websites, fellow moms, lactation consultants, mommy-and-me group leaders, and the media.


We get no guidance or education on bottle feeding from professionals, and when we seek it out, we get conflicting info peppered with constant reminders of why we really should be breastfeeding, so why even bother attempting to find the best type of formula, since they’re all crap, anyway?


The reasons that breastfeeding advocates and the media give for us “failing” to meet their recommendations are so far from our lived realities, it’s hard to believe we exist in the same dimension.


Everything having to do with babies these days – from conferences to books to radio shows – focuses on breastfeeding. If bottle feeding is mentioned, it’s typically in the context of Things To Avoid At All Costs Unless You Really Have to Go Back to Work In Which Case You Should Just Pump or At Absolute Worst Use Donor Milk.


Yes, there are many breastfeeding advocates who come to troll on our pages and provoke our anger. And yes, there are formula feeders who will do the same on breastfeeding pages. Ignore these people. They do not matter. There are more of us middle-ground, moderate folks than there are of them.


While mom-to-mom cruelty is certainly a part of the problem, we know that there’s a much larger battle to fight – the battle of scientific illiteracy and paternalistic advocate-physician/researchers who are blinded by a religious belief in breastfeeding. If the bullies didn’t have certain unnamed, infamous physicians leading their charge – people who encourage the shaming and ridiculing of formula feeding parents – they wouldn’t have so much power. If society had a better understanding of the reality of infant feeding research, and could acknowledge that correlation and causation are two different animals, it would take away the fear and guilt, on ALL sides.

We just want to be equal with you. Not better. We’re not even asking you to think that formula and breastmilk are equal – that’s a question of science, of risk/benefit analysis, and individual circumstance. All we are asking is that we do not equate the type of liquid going into our children’s bellies with how much we love them, or how bonded we are with them, or how strong/capable/dedicated we are as parents.


This is not about photos. This is not about who has it worse. This is not even about breastfeeding and formula feeding, anymore. It’s about how we view motherhood as a competition, how the powers that be monopolize on this competition, and how the media loves to encourage it. Instead of focusing on brelfies or bressure, let’s get the hell off Instagram and start making an impact in our own communities, with our own friends and fellow parents. Ignore the hype, and focus on the help.

A picture tells a thousand words. But they don’t have to be negative ones.


You don’t need to know why I don’t breastfeed, because it shouldn’t matter.

This past week, Emily Wax-Thibodeux’s excellent essay, “Why I don’t breastfeed, if you must know”, went viral. As it should have. It’s a cutting, heartfelt expose of just how ridiculous the pressure to breastfeed has become, made all the more powerful by the author’s recounting of her double mastectomy.

Unfortunately, even breast cancer didn’t stop the haters from hating.

“95% of the time people don’t breastfeed for reasons other than terminal illness. This is a red herring argument. She shouldn’t feel bad for having a legitimate reason for not breastfeeding and if she does then its really a personal problem,” said one comment on a thread.

“We all understand should and can are different. A mother who cannot breast feed is different than a mother who can but chooses not to…Breast milk is better for an infant than formula, I don’t think there is a doctor, nurse or midwife who would say that formula is better…Shame people would criticize this mother who CANNOT breastfeed like it was her choice,” wrote another (who happened to be male).

And then there was the woman who insisted that “(t)here is absolutely zero systematic or general judgment against infant formula or bottle feeding. It is the absolute expected norm by the majority of adults and parents in our culture. No one cares if you feed your baby infant formula or use a bottle…Most children start on the breast. Most children are weaned. Most children are given formula and fed with bottles. There is no public backlash against infant formula or bottle feeding. But here’s an article that pretends “infant formula shaming” is some actual thing. No. It isn’t. Not in the real world of critical thought and evidence. The data doesn’t support this notion at all.”

In the FFF community, there was tremendous support for Wax-Gibodeux’s piece, but an underlying concern about the title – because why must we know why she isn’t breastfeeding? Is shaming more acceptable for some mothers than others? What is the litmus test that rewards us with a breastfeeding “pass”? If a double mastectomy doesn’t quite cut it, I don’t know what will.

So maybe we should stop giving reasons altogether.

For those who fear formula as a product, no reason in the world is sufficient for a baby to be given anything other human milk. It doesn’t matter if the baby has to be wet nursed by someone with an unknown medical history – that is still better than formula.

For those who like to shame mothers – because that’s what it really is about, enjoying the act of shaming, of making yourself feel superior, or feel better about your choices by questioning those of others – no reason in the world will make a mother above reproach. She could always have done more – after all, breastfeeding is 90% determination and only 10% milk production, as a recent meme proudly stated. Best case scenario, she might get pity – but pity carries its own heavy scent, similar to the sour stench of shame.

Giving a reason for why you didn’t breastfeed is pointless.

That doesn’t mean telling your story isn’t important, because our narratives matter; they help those floundering in their own messy journeys make sense of what’s happening and find community with those who’ve been there. But there’s a difference between telling your story and owning it, and telling it to defend yourself. One gives you power, the other takes it away. 

We are at a turning point, I hope. Jessica Martin-Weber of The Leaky Boob has taken a stand against romanticizing the reality of breastfeeding, and is helping those in the breastfeeding community feel comfortable with bottle (and formula) use. When one of the leading voices in breastfeeding advocacy speaks out against a culture of fear and rigidity, that means something. Wax-Thibodeux’s piece has brought many powerful voices out of the woodwork, allowing women who’ve swallowed their shame to regurgitate it, and make the uninitiated understand just how sour it tastes.

Now is the time to draw a line in the sand. This conversation has moved beyond breastfeeding and formula feeding and whether one party is more marginalized than the other, or how superior one product is nutritionally to the other. We’ve been there, done that, and nothing has really changed. We’re all still hurting. We’re all still feeling unsupported, unseen, and resentful, like a 3-year-old with a colicky new sibling. Now, we need to stand up, collectively, and say it doesn’t matter why I am feeding the way I am. It is not up to anyone else to deem my reason appropriate or “understandable”. I’m going to stand up for anyone who has felt shamed about how she’s feeding, instead of just people who’ve had identical experiences to me, or those who I feel tried hard enough. 

A breastfeeding advocate shouldn’t be afraid to admit she questions aspects of the WHO Code. A breast cancer survivor shouldn’t have to have awkward conversations about why she’s bottle feeding. A woman who chooses not to breastfeed for her own personal reasons should not have to lay those reasons out in front of a jury of her peers.

This Tower of (breastfeeding) Babble has reached a fever pitch. It’s time for it to come down. Pick up your axe and start chopping. And next time someone asks, simply tell them, “You don’t need to know why I don’t breastfeed. Because it shouldn’t matter.”


Win-win or lose-lose: Study suggests breast may not “beat” bottle in multiple long-term outcomes

Every morning, I receive Google alerts for several terms: breastfeeding, formula feeding, infant formula, breastmilk, etc. And every morning, I brace myself, waiting for the inevitable headline that will cause panic among bottle feeding moms, or re-ignite the incessant argument between breastfeeding advocates and formula feeding parents (as if it ever needs reigniting – it’s like one of those trick birthday candles, always sparking back to life even after you’ve wasted all your breath), or force me to take some semblance of a “position” on an issue that is hardly ever black and white.

One might expect that this morning, I would’ve broken out in that annoying Lego Movie song. You know, ’cause everything is awesome!!!!!



News broke that a study out of Ohio State, which examined sibling pairs where one child was breastfed and the other formula fed, had found that there was no statistically significant advantage to breastfeeding for 11 outcomes. These outcomes included things like obesity, asthma, and various measures of childhood intelligence and behavior. As the study explains:

“Breastfeeding rates in the U.S. are socially patterned. Previous research has documented startling racial and socioeconomic disparities in infant feeding practices. However, much of the empirical evidence regarding the effects of breastfeeding on long-term child health and wellbeing does not adequately address the high degree of selection into breastfeeding. To address this important shortcoming, we employ sibling comparisons in conjunction with 25 years of panel data from the National Longitudinal Survey of Youth (NLSY) to approximate a natural experiment and more accurately estimate what a particular child’s outcome would be if he/she had been differently fed during infancy…


Results from between-family comparisons suggest that both breastfeeding status and duration are associated with beneficial long-term child outcomes. This trend was evident for 10 out of the 11 outcomes examined here. When we more fully account for unobserved heterogeneity between children who are breastfed and those who are not, we are forced to reconsider the notion that breastfeeding unequivocally results in improved childhood health and wellbeing. In fact, our findings provide preliminary evidence to the contrary. When comparing results from between- to within-family estimates, coefficients for 10 of the 11 outcomes are substantially attenuated toward zero and none reach statistical significance (p < 0.05). Moreover, the signs of some of the regression coefficients actually change direction suggesting that, for some outcomes, breastfed children may actually be worse off than children who were not breastfed.”


Source: Colen and Ramey, Is Breast Truly Best? Estimating the Effects of Breastfeeding on Long-term Child Health and Wellbeing in the United States Using Sibling ComparisonsSocial Science & Medicine, Available online 29 January 2014

I will admit that the comments made in several news outlets by the lead author of this study, Cynthia G. Colen, have made me want to run through the streets, acting as a one-woman ticker-tape parade in her honor. (Case in point: “I’m not saying breast-feeding is not beneficial, especially for boosting nutrition and immunity in newborns. But if we really want to improve maternal and child health in this country, let’s also focus on things that can really do that in the long term – like subsidized day care, better maternity leave policies and more employment opportunities for low-income mothers that pay a living wage, for example.”) But I’m not celebrating the results of this study, any more than I’d celebrate one that said formula feeding caused children to sprout green hair from their chiny-chin-chins and opt to live under bridges.

Why? Because this shouldn’t be a freaking contest.

The backlash that comes out of studies like these feels more like if someone came out with research that claimed fried Oreos were just as healthy as raw kale. Instead, we should be approaching it as if someone came up with a way to make a vitamin supplement that would offer similar benefits to kale, for those who hated the taste. One is natural, one is synthetic; one is manufactured, one exists organically. But for those of us who don’t or can’t eat raw kale on a daily basis, a good substitute is a godsend. (And maybe helps us justify those fried Oreos. A girl can dream.) Now, a study showing comparable effects of the supplement to the organic kale would not negate the fact that kale, grown in your own garden, is a nutritious, amazing thing – and tastes quite delicious to those of us who have a palate for it. If we started telling the kale aficionados that the supplement was better in some way, that would be a problem. But if the people who loved kale insisted that the supplement wasn’t a valid option and was somehow morally wrong, that would be a problem, too. Chances are, if we were really talking about kale, nobody would care all that much. The people who liked kale would eat it, and those who didn’t, might opt for the supplement – feeling confident due to the research that suggested the supplement was a viable option.

But we’re not talking about kale. We’re talking about breastmilk. And that, apparently, is where we all fall apart, and are rendered completely incapable of rational, measured discussion.

What the Golen/Ramsey study shows should not be controversial. The results should be reassuring- evidence that formula feeding does not condemn a child to a life of obesity, poor health, and lackluster intelligence; proof that whether a woman chooses, or is capable of, feeding a baby from her breast is not what defines her as a mother.

Imagine, for a minute, if we didn’t compare breast and bottle, but rather celebrated BOTH as valid, safe, healthy options for mothers and babies. Accepting that formula has legitimacy – that there is a reason it was invented (out of a need and a desire for a safe breastmilk substitute), and a reason why a woman may decide that a substitute is preferable – should not threaten those of us who celebrate breastfeeding. Yes, we should continue to rage against predatory formula marketing, especially in the developing world. Yes, we should speak up and speak out when companies (hello, Delta) retreat to 1953 when they express their breastfeeding policies. (For that matter, we shouldn’t need breastfeeding policies – if children are allowed, breastfeeding should be allowed. End of story.) Yes, we should ensure that women are entitled to adequate pumping breaks, and given solid breastfeeding assistance, and are supported by solid research regarding medications and breastmilk and best practices from pediatric professionals. But none of that means formula has to be Public Enemy No. 1. None of that means parents who formula feed should be left floundering due to an embarrassing lack of support and education. And for the love of god, none of that means we should be smugly celebrating when formula fed babies are shown to fare poorly, or gleefully rejoicing when and if the opposite occurs.

This is one study, with its own set of limitations and biases, like any other study in the modern canon of infant feeding research. But it’s a good study, artfully designed, and one that raises some extremely important questions about how the emphasis on feeding babies might be distracting us from the real work of supporting better maternal and childhood outcomes. Because speaking of retreating to 1953, it’s awfully easy to shove the responsibility for future generations onto women’s chests, rather than addressing true social inequities that can impact children’s lives. Maybe if we stopped wasting energy trying to prove how evil formula is, and just accepted it as part of life – not a slap in the face to our mammary glands, or an excuse for idiots to treat nursing mothers as horribly as they do now – we would have more energy to understand and destroy these inequities.

Or, you know, we could do what we always do and spend time looking for vague connections to the formula industry to discredit the study authors. Because that’s a really great way of helping families thrive.




FFF Friday: “I’ve come to loathe the breast is best rhetoric…”

Today, I posted an incredible piece from my friend Amy West on the Facebook page. Amy is a breastfeeding counselor and advocate, but more than that, she is an independent thinker who understands that the way we support breastfeeding and formula feeding mothers (and fathers) might need an overhaul. I don’t doubt that she’ll receive some backlash for her viewpoint, just my friend Jessica over at The Leaky Boob did for daring to “work” with me (someone who, according to some of her recent critics, should be her sworn enemy. I kid you not). 

But people like Amy and Jessica are the face of the future – supporters of women and families first, who also advocate for and support breastfeeding moms. I feel confident that they are ushering in a new era of breastfeeding advocacy, and I expect it to do more in a few years than decades of the status quo has accomplished. 

In that spirit, I wanted to share Kara’s FFF Friday. It’s a bit different than the usual fare, but I absolutely love it. She describes the flaws in our current rhetoric, which the people perpetuating these flaws don’t want to hear coming from me (because of my admitted bias and position as “formula feeding defender”); I’m hoping that because Kara is a breastfeeding mom, she might carry more weight with these folks. Because as I keep trying to explain – to no avail – my work is not about promoting formula or knocking breastfeeding. It’s about reforming a system that leaves more than half of us struggling with  a lack of support and information, and the other half floundering around with something that passes as support, but often looks more like a pass/fail system that relies on fear and comparisons as a motivational tool.

Anyway. Happy Friday, fearless ones,



Kara’s Story

My breastfeeding story is a success story, because I’ve breast fed my twins for six months now, but I still experienced a lot of pressure, uncertainty and guilt as a result of “lactivism,” so I agreed to share it.

I’ve come to loathe the “breast is best” rhetoric.  I went into breast feeding knowing LLL and others were overstating the benefits of breastfeeding and believing that formula is just fine no matter why a family chooses it.  But I had some difficulties getting breastfeeding started with my premature twins.* They were in the NICU for over a week.  Throughout my pregnancy I assumed breastfeeding would be easy for me.  I don’t know why since the process of getting pregnant certainly wasn’t (I started trying after reaching what doctors like to call “advanced maternal age” and ultimately succeeding with IVF), but I had read enough to know to request a breast pump a few hours after the surgery.  Things started well – I was producing amazing quantities of colostrum and the nurses started turning away my contributions before my babies came home.  But my son was on CPAP and the NICU nurses wouldn’t let me take him out of his plastic box for several days. My daughter wasn’t getting many interventions but only weighed four pounds at birth and although we tried in the NICU, she was too weak to nurse.     I gave up trying to nurse them there and focused on pumping.  I let the nurses give them pacifiers.  I told them to use formula if there ever wasn’t enough colostrum/milk.  And I ignored the hospital lactation consultant who told me I needed to pump a minimum of eight times a day to get my supply up in favor of sleeping through the night while I still could.  That was all wrong, I guess?  But here’s the thing: I hated watching them cry in their incubators with nothing to comfort them.  And I wanted my babies to be fed and grow well so they could come home as soon as possible.  I could see with each of the six pumping sessions I did manage that my supply was just fine.  The LCs gave me a little schedule of target volumes for twin moms pumping in the hospital, and I was ahead of schedule.  The hospital LCs never believed me and insisted I had to pump more often.  But I hated pumping because not only did it hurt, but the sound of the machine had already turned into a voice saying “NIPPLE, NIPPLE, NIPPLE” mockingly.

My little Twin A and Twin B came home at 5.5 and 4.5 pounds, and both were pumped bottle babies.  I still wanted to breastfeed and escape the pump, but couldn’t convince them and decided to give a private LC a try.  I got a great one who *didn’t* bully me or pressure me, and with her advice and support, in six or eight weeks (who can remember?) I had them nursing full-time.  It was hard work, and painful, but it was my choice to struggle through it because a) I’m a single mom without a ton of money and it was cheaper, and b) I had freaking TWINS and tandem nursing, once I mastered it, was the most efficient way to feed them – both at once, with the least amount of cleaning up to do afterwards.  I also got through it because I allowed myself the option of formula if it ever was too much for me.  I kept some pre-mixed formula in the apartment even though the advice I got from the pregnancy boards run by self-proclaimed “boob nazis” was not to do that, because I’d be too tempted to use it and quit.  I stuck it out…because I had the peace of mind of knowing that formula was right there if there was ever some night when I couldn’t take it anymore.**

I never planned to breast feed past six months, but when we hit that milestone a couple weeks ago I suddenly found myself doubting.  Was six months really enough?  Was formula in fact an evil poison?  Didn’t my premature twins need as much extra advantage as I could give them?  How could I be such a bad mom to want to quit now that breastfeeding was finally painless and routine?  I found myself desperately looking for support for weaning at six months and finding little.  Even the advice I found on how to wean was predicated on the assumptions that my children had never had a bottle in their lives and were ready to transition to a full solid diet, no longer requiring breast milk, but just nursing for comfort.  Eventually I found Fearless Formula Feeder, and thank goodness!  But what happened to the person who ignored all the lactivist advice in the hospital?

Online breastfeeding support groups happened, is what happened to her.  After I stopped working with my awesome LC, I consulted sites like Kellymom for information about minor issues as they arose (the thing about how after six weeks breastfeeding is easy peasy?  Not entirely true).  And I like to get information from more than one source (what can I say?  I’m a researcher at heart) and read a lot of these sites.  I found myself questioning my initial position that breastfeeding didn’t provide that many health advantages to babies.  I started to wonder “what if they’re right?”  I went through a period of deep anxiety when I thought about weaning.  The times I had referred to the breast feeding support sites had insidiously planted these doubts even though I had done my research and debunked them before I started reading them. And these sites are the top hits of any online search for breastfeeding information, unfortunately.  You have to dig deep to find the opposing views, and until I found them I felt like crap.  I didn’t want to be selfish!  But I really did want to stop and I kept digging for information until I found what I needed (which was just reaffirmation of what I already knew)

I’m going to be gradually reducing our nursing sessions over the next few weeks, because six months is plenty.  Because I’m tired of plugged ducts and the fear of mastitis.  Because I’m tired of being bitten by two babies at the same time.  Because it will be hard to pump when I go back to work full time.  Because I don’t want to pump when I go back to work full time.  Because I’d like to go out on a weekend for more than four hours without dragging my pump around and using it in a dirty public restroom to avoid engorgement.  Because my twins are doing great and eating solids now.  Because breastfeeding was never how I bonded with my babies.*** Because formula is a pretty darn good food.  Because I want to, and it’s my choice, and I shouldn’t ever have had to question myself about it.


*  And as a whole separate issue, I was pressured by strangers about not letting my doctors ever tell me induction was necessary because it would lead to an unnecessary c-section…but with my blood pressure skyrocketing it was necessary.  And you know what?  I did get an epidural and I did end up with an emergency section.  But I also ended up with two live children and I can sneeze without peeing, so there.

** Eventually I joined some twin parent boards and found them a lot more supportive of both supplementing and exclusive formula feeding.

*** You can’t be fully absorbed gazing into a baby’s eyes for too long when you’ve got to make sure you devote equal attention to the second baby, who also likes to squirm and try to fall off the pillow, and the other has reflux and you have an overactive letdown so you spend a lot of nursing time mopping up,**** and both of them nurse with their eyes shut anyway.

**** As glad as I am to have breastfed for six months, here is the memory of it that will last the longest for me: Tandem nursing and the refluxy baby finishes first.  He requires immediate burping, so I carefully lift him up without disrupting the latch of the other…and he promptly vomits down my back.  Since still-nursing baby is not gaining as well as the pediatrician likes and I am strapped to a giant double nursing pillow, so I find myself unable to get up, crying as vomit trickles down my back and puddles on my sheets.  At 3 AM.  This is what breastfeeding is for me. 


Share your story, or your thoughts: email me at


Related Posts Plugin for WordPress, Blogger...