News Bites: Lack of support for breastfeeding moms; Organic formula hyperbole

My blood pressure is rising, and I’m mid-tirade directed at my poor, innocent husband when it hits me: It must be time for a good, old fashioned, FFF news roundup.

Those of you who’ve been with me for awhile probably remember that I used to do these frequently, especially when something in the news cycle gives me a bout of psychologically-induced hives. So it may come as no surprise that I felt the urge this morning, when not one, but two frustrating pieces popped up in my news feed.

First up, we have coverage of a new study in the aptly titled “Morbidity and Mortality Weekly Report”, claiming that women are still not getting sufficient support in American hospitals for breastfeeding.

According to NPR:

Most hospitals around the country aren’t doing a good job of helping new moms who want to breast-feed, researchers report Tuesday..Several common practices at the institutions may actually prevent moms from sticking with breast-feeding for six months — the duration thought to be most healthful for babies.


Epidemiologists at the CDC surveyed more than 80 percent of the birthing centers across the country about the support they give new moms trying to breast-feed. About half of those surveyed said they implement five of the 10 practices recommended by the World Health Organization. By comparison, only a third of hospitals were hitting that mark in 2007.

Looking at the study itself, the news is far from dire. In fact, according to the CDC report of the evidence, “nationally, hospitals implementing more than half of the Ten Steps increased from 28.7% in 2007 to 53.9% in 2013.” That’s a pretty significant jump, but the media decided to go with the story that “hospitals aren’t doing enough to support women in meeting breastfeeding goals.”

This is me, reading these articles. Not really. But it SO could have been.

This is me, reading these articles. Not really. But it SO could have been.

But what is the real story, here, and how come no one is talking about it? What this study tells us is whether hospitals are following what they are ‘supposed’ to do to help improve breastfeeding rates. These are things like providing mandatory breastfeeding classes, holding breastfeeding support groups (or referring out to La Leche League, etc.), making sure no pacifiers are given to neonates, and outlawing the use of “unnecessary” formula supplementation – something which the NPR piece gives ample air time:

And, too often, that’s not happening. For example, about 75 percent of hospitals still give healthy babies some formula in the first days of life, even when moms say they want to breast-feed.


“Even a little bit of formula may undermine a strong start to breastfeeding,” Frieden says.

Again, let’s go back to the actual study. All it tells us is that “less progress occurred in limiting non–breast milk feeding of breastfed infants (20.6% to 26.4%)”. “Breastfed infants” means infants who start out breastfeeding, presumably. But many, many parents end up supplementing by choice or by necessity – and the study does not differentiate between these situations and the type of scenario the media is imagining, where innocent breastfed babies are stolen from their parents in the night and force-fed Enfamil.

This study is not news. This study is not, in fact, telling us anything about whether women are getting “support”, at all. It is telling us whether the number of hospitals following government guidelines for raising breastfeeding rates is going up (it is). It does not correlate that number with any increase in actual breastfeeding rates. It does not survey women and ask if they felt supported in achieving their breastfeeding goals. And it certainly does not factor in the needs or experiences of women who do not want to breastfeed, or physically can’t.

But it’s not the study I’m worried about – it’s the media’s insistence on sticking to one stale, tunnel-visioned narrative, insisting that what women need is support, but defining “support” as more control over their decisions and bodies; deciding that “supporting breastfeeding” means what one group decided it means, rather than listening to women, and asking them what would really help them achieve their goals. We end up exactly in the same place we were before: with hospitals implementing pro-breastfeeding policies and then wondering why their patients and nurses are making them so difficult to carry out. (Maybe because they aren’t the right policies, or they aren’t being implemented in the right way.)

Moving on… to a piece that could have been a nice little gift to formula consumers, something that actually made a case for better transparency in the formula industry, in the popular New York Times ”Motherlode” column. If you’re not familiar with Motherlode, it usually features well-written personal essays on parenting, with the occasional news, book review, or opinion piece. Today’s column, “What Does ‘Organic’ Mean For Baby Formula”, was none of these, but rather a bizarre bit of “investigative reporting” that would have fit better over on Food Babe’s blog. The author of the piece writes:

…I began to question what, exactly, were the unexpected and confusing things I was reading on the ingredients lists.

The biggest surprise was that in many of the formulas, the main ingredient was not milk, but highly processed, refined sweeteners (often listed as organic glucose syrup solids). I generally avoid feeding refined sweeteners — even organic ones — to my children. I was even more taken aback to see how many also included ingredients one wouldn’t typically expect to find in organic food — like synthetic preservatives.

I won’t bore you with all the specifics of why formulas contain sweeteners, synthetic preservatives, and “confusing” ingredients, except to say this: companies have done their R&D to make the healthiest product possible for the lowest possible price. There may indeed be less processed or more premium ingredients available, but we don’t have any research proving that more expensive or organic formulas are any better for a child’s health, so there doesn’t seem to be justification for using materials that would raise the cost. (Note: If you do want more info on formula ingredients, visit Dr. Chad Hayes’ fantastic website).

Now, to be fair, I understand the author’s confusion; if you’re used to buying high-end organic food, the back of a formula can – organic or not – is going to be super intimidating. But it’s important to remember that the definition of organic food is simply about the sources of the ingredients:

“What is organic food? Organic food is produced by farmers who emphasize the use of renewable resources and the conservation of soil and water to enhance environmental quality for future generations.  Organic meat, poultry, eggs, and dairy products come from animals that are given no antibiotics or growth hormones.  Organic food is produced without using most conventional pesticides; fertilizers made with synthetic ingredients or sewage sludge; bioengineering; or ionizing radiation.  Before a product can be labeled ‘organic,’ a Government-approved certifier inspects the farm where the food is grown to make sure the farmer is following all the rules necessary to meet USDA organic standards.  Companies that handle or process organic food before it gets to your local supermarket or restaurant must be certified, too.”

-Consumer Brochure, USDA National Organic Program,

To clarify, in organic foods, the ingredients used can’t be derived from sources using GMO, pesticides, antibiotics, and so forth. It doesn’t mean that the food is healthy or whole. You could make an organic version of a Twinkie, but it would still be a Twinkie.

Now, in the case of formula, we are talking about something healthy – but also highly processed. This is chemical food, and it should be chemical food. It is a substitute for human milk; hence, the only way it can come close to human milk is by being recreated in a lab. Every mammal creates milk specific to its species; having the primary ingredient of human infant formula be cow’s milk has to do with cow’s milk being cheap and readily available, and easy enough to alter to be suitable for human consumption; it’s not because cow’s milk is particularly good for humans, whether it comes from the udders of grass-fed cows or not. 

I honestly do not want to criticize the author of the NYT piece. She sounds like a very well-intentioned mother. But I do think that an article which seems on the surface to be investigative journalism instead of an opinion piece, could be misleading to other well-intentioned parents, who will now feel that they have to pay exorbitant amounts of money to feed their children “healthy” formula: 

On a friend’s advice, I began to research two formulas made in the European Union, HiPP and Holle. It seemed pretty clear: these formulas came closer to what I would expect in organic baby food. No refined, high-concentrated sweeteners. No synthetic DHA or ARA. No synthetic preservatives. HiPP says it analyzes all its agricultural projects for traces of over 1,000 different substances. The main ingredient in Holle’s formula is milk that comes from pasture-fed cows raised on biodynamic farms.


Holle and HiPP are great products. And the author’s assertion at the end of her article, that parents need better options, is spot-on. I want there to be more communication between formula manufactures and parents, so that we all understand why certain ingredients are in our babies’ food. I want there to be ample options for kids with all sorts of food sensitivities; formulas for vegans; formula for parents who care about grass-fed cows. Because that’s the beauty of using a manufactured product – it can be altered. It can evolve.

What I don’t want is fear-mongering or confusion running around, when parents are already stressed and scared about formula use. I want parents to know that while DHA/ARA is indeed hexane-extracted, that does NOT mean that any hexane remains in the DHA/ARA. I want them to know that the reason many companies don’t use lactose is not because it’s expensive, but rather because cow lactose is different than human lactose, and many babies have a hard time tolerating it. I want them to know that yes, ingredients matter, and it’s absolutely okay to care about what goes into your body and your baby’s body (not that you need my permission or anyone else’s to feel how you’re going to feel, but you know what I mean), but the formulas on the market now have been tested, highly regulated, and proven to work beautifully for the majority of babies.

Insisting that we have more choices and better consumer knowledge does not have to mean throwing the generic brand-fed baby out with the bathwater. Let’s stop and talk to the people who are creating these formulas, and not just stop at the Cornucopia Institute (because both sides are affected by very strong bias, and you need to balance one extreme with the other), as well as some totally independent, science-minded folks. Let’s aim for truth and nuance rather than absolutes and middle-class food politics.

And now, I’m going to go celebrate the Cubs securing their place in the post-season, because that’s the only news really worth talking about, anyway.


***For a great breakdown of the organic formula options currently available in the US, visit the Incredible Infant’s Guide to Organic Formula.***



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

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

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

- The FFF

“Mothers Deserve Better”:

An Interview with Christie Del Castillo-Hegyi, MD.

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

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


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


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


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


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

FFF: What sparked your interest in this issue?

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


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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

CDCH: These are my core recommendations:

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


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


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


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

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

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

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

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


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

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

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

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

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

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

Vist Dr. Del Castillo-Hegyi’s Facebook page for more information:



A World Breastfeeding Week Plea: Stop celebrating, start collaborating

Usually, I’m all over the place this week. Getting quoted in the requisite “it may be breastfeeding week but gosh darnit some women still find exclusive breastfeeding super hard” articles. Posting my own stuff here on the blog, or over on HuffPo. Talking about #ISupportYou and pissing off hundreds of people in the process, because they see it as a veiled attempt to “steal the thunder” from World Breastfeeding Week.

But this year, I’m all but invisible.

Part of this was unintentional. I’ve been going through some stressful career-change mishigas, dealing with the inevitable gaps in childcare that occur between camp and school, entertaining a ridiculous number of visiting extended family members. I’ve been too exhausted to blog, or talk to media sources, or self-promote (because let’s be honest – that’s a part of what all of us parenting bloggers do. Even the most altruistic of us. Even those of us who don’t depend on hits or advertising or who never make a cent off their blogs. We write because we want to be heard; we pray for bigger audiences, book deals, evidence that we’ve made some sort of impact. I happen to be rather shitty at this, which is why I don’t blog much anymore. I don’t have the stomach for that part of the job).

Another part of my conspicuous silence has been intentional, however. Probably more than I care to admit. See, I’ve been focusing my efforts on the supportive stuff. Reaching across the aisle, trying to understand all facets of this debate, and hoping that by creating better resources for all moms, I can help stop all the guilt/anger/resentment/confusion/hurt. I know that breastfeeding is important to many, many women. I want those women to succeed, and feel happy and proud and supported. So this year, I wanted to try and stay out of World Breastfeeding Week drama like I try and stay out of my kids’ sibling squabbles.

Yeah. Because that works so well with my kids.

The problem is, I also want formula feeding mothers to feel happy and proud and supported. And for some reason, it’s not okay to want both of these things. It’s ok to pay lip service to it, to claim #ISupportYou and tell formula feeding moms that celebrating breastfeeding isn’t about them. But if you actually do the work you need to do to ensure that non-breastfeeding parents are supported, you are violating WHO Code. You are taking attention away from the women who “need it”. You are stealing…. what? Resources? Sympathy? One-up(wo)manship?

I tried to stay out of it. I really did. I held my newly-minted CLC certification close to my non-lactating chest and bit my tongue.

And then the articles came, and came, and came. And so many this year were not about the benefits of breastfeeding, but rather how hard it was. Or how hard it was NOT to breastfeed. How this mom felt like she was poisoning her baby, or this one felt like she’d be booted from the “mom club” because she didn’t wear the EBF badge.

So much guilt/anger/resentment/confusion/hurt. None of it is stopping. There’s more this year than ever before.

Then this happened.

And I heard my community inwardly wince. Not for the reasons you might think. Not because they didn’t think it was a beautiful image, and not because it glamorized something that had been messy and painful for most of them, although those certainly were thoughts that some of us had to squash down into that endless pit of mother-guilt. No, it was because it was yet another image of a breastfeeding celebrity, with headlines and stories that spoke of her bravery for normalizing nursing, and comments all over the place about how breastfeeding was finally being celebrated.

I think, for many of us, it was the “finally” that did it. For many of us, it would seem far braver for a celebrity to do a shoot with her bottle-feeding her kid with a can of formula in the background. We have only seen breastfeeding being celebrated. There’s so much partying going on, and we feel like the crotchety old neighbors calling the cops with a noise complaint. But you know, it’s late, the music is loud, and we’re tired.

Now, just to be clear – I’m talking about breastfeeding being “celebrated” That celebration doesn’t do us much good. It does not mean that it is easy for moms to nurse in public. Obviously, it isn’t. Or that lactation services are plentiful and accessible to all. Obviously, they aren’t. Breastfeeding is celebrated, but that doesn’t stop it from being difficult for the new mom in the hospital, whose birth didn’t go as planned. Or the one who has to go back to work 2 weeks postpartum. Or the one with a job not conducive to pumping. Breastfeeding is celebrated, but not when you’re overweight. Or when you’re nursing a toddler.

Idealized images in the media of what breastfeeding looks like do not normalize nursing. In fact, I’d argue it fetishizes it – not for men, so much, but for women. Now, we don’t just have to feel inadequate for not fitting into size 2 jeans a month after giving birth, but we need to feel inadequate if we don’t meet the feeding norm and make it look gorgeous and natural and easy.

Please do not misread what I’m saying here – talking about breastfeeding, supporting breastfeeding, and implementing changes to make breastfeeding easier for those who want to do it are important, admirable, and necessary goals, as far as I’m concerned. But the comments I saw coming from my community after this photo hit the news were not about any of these things. They were from women feeling totally drained, frustrated, and alienated after a nearly a week of hearing how inferior their feeding method was, who were sick of being told they were defensive or that they feel guilty if they tried to stand up for themselves. This story was the last straw. It’s weird, when you think about it – it wasn’t the piece on the risks of formula, or the memes about the superiority of breastfed babies – what broke the camel’s back was a seemingly innocuous spread of a gorgeous, confident actress proudly nursing her baby.

This is what perpetuates the cycle of guilt/anger/resentment/confusion/hurt: our lived experiences are so damn different, that it’s like we’re constantly talking at cross-purposes. The nursing mom who is the only one in her small town not using a bottle sees a photo spread like this as thrilling, victorious, self-affirming – as she should. The formula feeding mom living in Park Slope who carries her formula-filled diaper bag like a modern-day hairshirt sees the same spread as just another celebrity being held up as a pioneer, when she’s only doing what’s expected of a woman of her stature – as she should. Both are right. Because both are personal, emotionally-driven responses.

Earlier this week, I said that deciding how to feed your baby is just one of a myriad of important parenting decisions. But somehow, it’s become the most important one. We cannot expect formula feeding moms to support their breastfeeding sisters when they don’t receive the same support. We just can’t. It’s not fair, and it’s not realistic. I feel like that’s what I’ve been asking of all of you, and somehow I just woke up to that fact.

Why are there still articles talking about how shitty we feel for not breastfeeding, instead of articles talking about what’s being done to change this? Where is the news story about the doctors who are saying enough is enough (because I know they are out there – many of them contact me, and I appreciate these emails, but I wish they were able to say these things publicly without fear of career suicide)? Where’s the NPR program about ways we can improve breastmilk substitutes so those who cannot or choose not to nurse aren’t left hanging? Where’s the Today Show, The View, The Katie Show, doing segments on why women are REALLY not meeting breastfeeding recommendations, instead of segment after segment on how brave so-and-so is for posing nursing their newborn on Instagram, or talking to dumbasses on the street about the “appropriate” age for weaning?

When we stop “celebrating” and start normalizing and supporting and being realistic about how different life can be even just a street away, maybe World Breastfeeding Week can have it’s proper due. Maybe we can actually talk about ways to help women in the most dire straits feed their babies as safely as possible – clean water, free breast pumps, free refrigeration, access to donor milk.

I want to be able to be silent during World Breastfeeding Week. It shouldn’t have to be “overshadowed” by emotional, personal pieces about breastfeeding “failure”. It shouldn’t be a time for articles about not making formula feeding moms feel “guilty”. These words shouldn’t even be part of our infant feeding lexicon, for godsakes. Failure? Guilt? For what?

This year, I want us to stop celebrating, and start having some calm, productive conversations with people outside your social circle. For many of us, the celebration feels exactly like high school, when the popular kids had parties and we sat home watching Sixteen Candles for the thirty-fifth time. That’s not to say breastfeeding isn’t worth celebrating, but the end goal should not be one group feeling triumphant and the other feeling downtrodden. Formula feeding was celebrated for decades too – and that celebration made the current atmosphere of breastfeeding promotion necessary. Please, let’s learn from our mistakes. Let’s move on. Rip down the streamers, put away the keg, and open the doors to the outsiders looking in. You never know – they could end up being the best friends you’ve ever had.


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

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

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

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

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

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

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

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

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


Concerned Members of the Community



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


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

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



Disaster in the Philippines: Why overzealous breastfeeding promotion has no place in relief plans

Dear FFF,

We are based in Manila which, thankfully, was spared from the brunt of typhoon Haiyan. As you may be aware, our fellow Filipinos from the other islands of Leyte and Palawan suffered from this catastrophe. Aid has been slow in coming, and the situation is now miserable and desperate. Donations from all over the world are coming in, but the logistics of getting them to the people who need them are difficult because many of the islands are isolated and cannot be easily reached. Many have not eaten since Saturday. They also do not have clean drinking water and are living in the streets amidst rubble and dead bodies.

Which brings me to my question/issue – What is the best way to feed a baby in a crisis situation like this?

 Our Department of Health has BANNED donations of formula milk – powdered or pre-mix – because of the perils of formula and because it undermines breastfeeding.  According to the Department of Health, the best solution is to breastfeed, or if the mother is no longer breastfeeding, to give support towards re-lactation. If these are not feasible, then the next alternative is wet nursing. I do understand that this is the exact reason why formula has been deemed “dangerous – because preparation of formula in unsafe, unclean conditions (including using unclean water and bottles) can lead to diarrhea and infant mortality.  However, I also believe that the options given by the Department of Health practically require a mother to choose between death of a child by starvation and death by diarrhea.  They say re-lactation as if it was like turning on a switch. Most women who have weaned young babies likely had problems lactating in the first place. How likely is it that she would be able to re-lactate in the midst of the stress, chaos, and misery of a calamity? The Department of Health says that the solution is to provide breastfeeding support, counselling, and breastfeeding-friendly setups where breastfeeding can be encouraged.  In a situation where the most basic of necessities such as water, shelter, and medical care have not even reached the victims, it does not appear that anyone is currently equipped to provide these conditions that would foster breastfeeding in a crisis situation. Wet-nursing or donated milk is the next alternative presented. On wet-nursing, I do wonder if that is really a safe option, since it is possible to also contract disease from tainted breast milk. Again, in a calamity situation, who has the time and resources to check for infectious diseases when looking for a wet nurse?  On donated milk, I concede that this is probably the most viable option, but given the sheer number of people affected, I do not think that it is a sustainable source of nutrition for all the babies affected (given that several hundred thousand homes were affected). Babies need constant nutrition, and while donated milk may augment at the start, is it really sustainable to provide for the nutritional needs of all the victims in the coming days before they are moved to a safe and clean environment? 

And so, I think, banning pre-mix formula donations is a case of letting the principle of promoting breastfeeding defeat the principle of saving as many lives as possible.  Even the American Academy of Pediatrics concedes that pre-mixed formula is the last alternative when the other options are not feasible.  Our government, however, has taken the firm stance against formula and will refuse donations of pre-mixed formula.  Incidentally, pre-mixed is not readily available in the Philippines, but I’m sure it can be procured from other countries or even by local formula manufacturers if only it were allowed.

- S. T.


After receiving this email, I logged on to my computer to find several sources reiterating what the author had said. According to Gulf News,

Government and private hospitals in Manila called on nursing mothers nationwide to donate milk for babies in typhoon devastated central Philippines… Explaining the aim of the campaign, (Dr. Jessica Anne Dumalag of Manila’s Philippine General Hospital’s Human Milk Bank) said, “Milk from lactating mothers is preferred over formula milk, which is basically processed cow’s milk.”

The department of health which has been promoting breast feeding has a policy to prohibit the donation of formula milk for babies in temporary shelters, during a calamity….“Children are more exposed to allergy when they consume formula milk. We are also not sure if the water used to prepare formula milk is clean (that is why it is not recommended),” said Dumalag….Government and private hospitals including private organisations were organised to accept donations of human milk. Milk donations will be pasteurised, frozen, and kept in insulated containers before they are sent to evacuation centres in central Philippines, Dumalag said.


Concerns over water and sterile preparation of bottle feeds during disaster situations are valid and necessary. Several years ago, we had a lengthy debate here on FFF about this very topic; I’m well aware that if relactation or wet nursing is a possibility, it is without a doubt the safest option in natural disaster settings. Bacteria-filled water, poor sanitation, and lack of resources make formula feeding a deadly proposition; when formula feeding is seen to be “encouraged” in an at-risk population, lactation may be interrupted which can have long-term consequences (i.e., the family would then need formula on an ongoing basis, which could prove difficult if money or resources were an issue). I’m not disputing this, nor am I ignoring the fact that formula marketing in the Philippines is a hot button issue at the moment, and that breastfeeding promotion is in overdrive for reasons that I can’t fully comprehend, as a privileged Western woman.

But that’s not what this is about.

A policy that forbids powdered formula donations and encourages breastmilk donations is simply replacing one easily contaminated substance with another. Donated breastmilk – and this includes breastmilk procured by breastfeeding-related Facebook pages, speaking of privileged Western women – requires careful packaging, transport and refrigeration, not to mention screening for HIV and hepatitis B (the Philippines still has a low rate of HIV infection, but it’s rapidly increasing – TIME reports that every 3 hours a new case is now being diagnosed). There are still the same risks involved with sterilizing bottles, regardless of what’s filling them; nowhere in these news reports are people discussing the importance of cup feeding, for example – something that can significantly cut the chance of bacterial contamination.

There is, however, a substance that can be easily transported without refrigeration; that has a relatively stable and long shelf life; and which can be fed to babies in a perfectly sterile manner, at least in the short-term. That substance is ready-to-feed, pre-mixed formula, served in “nursette” bottles with pre-sterilized nipples (like these).

Granted, the cost of these supplies is rather high. But while I haven’t done the math, I’d venture to guess that the cost of procuring and safely distributing donor breastmilk would be just as prohibitive. And if people are ready and willing to donate RTF and pre-sterilized nipples, what would be the harm in allowing them to do so?

The answer is none. There would be no harm, except, perhaps, to the “cause” of breastfeeding promotion. That cause may be noble and important, but right now, it’s irrelevant. To put breastfeeding promotion ahead of feeding infants safely and in a timely manner is petty, short-sighted, and cruel. Think about it: would we discourage donations of processed, high-fat canned foods to disaster victims because of concerns over obesity, GMOs, or the environment? Or would we ensure that their immediate needs were met, and worry about preaching better health habits after the roads had been rebuilt and displaced families were settled into safe, warm homes?

The fact that Dr. Dumalog, quoted above, uses “allergies to formula” as a reason for forbidding RTF formula donations speaks to the irrationality of this policy. If a child is allergic to formula, there is also a chance s/he will react to something in a stranger’s milk. A breastfed baby may indeed react poorly to formula at first, but this is a case where the mom should receive plenty of assistance and encouragement to continue breastfeeding – not told to feed her baby via bottle with donated milk. With breastfeeding rates in the Philippines being what they are, it stands to reason that most of the babies without lactating mothers present are already formula fed – therefore they will probably do just fine with donated formula, even if it’s not the same brand. We’re talking about a little gas here, not a full-scale anaphylactic reaction.

Gulf News reports that “groups that promote breast-feeding in six hospitals and in several private clinics are part of the campaign.” A disaster situation is no place for “promotion” of anything but disaster relief. And the scariest thing about this is that the Filipino government isn’t alone in letting a hatred of formula get in the way of ration. The American Academy of Pediatrics also advocates for “screened human donor milk” before RTF (although they do, at least, acknowledge that this is an option). I have yet to see one study or agenda-free policy paper that actually looks at the viability of using donor milk as opposed to RTF formula with pre-sterilized nipples during disasters. If there is a logical reason behind these recommendations, I’d love to see it. All I can find are convoluted references to “breastfeeding being interrupted” (not an issue if we’re talking about babies who are already formula fed) and concerns about sterility and availability (absolutely valid, but just as valid in regards to donated milk, if not more so).

Governments must stop putting ideology above practicality. We are in desperate need of a neutral, informed, and rational voice to come up with better policies for infant feeding – policies that do not throw the cart before the horse, and end up running over its citizens in the process.

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