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.






FFF Friday: “This isn’t a post about how I tried to breastfeed my children and failed.”

Welcome to Fearless Formula Feeder Fridays, a weekly guest post feature that strives to build a supportive community of parents united through our common experiences, open minds, and frustration with the breast-vs-bottle bullying and bullcrap.

Please note, these stories are for the most part unedited, and do not necessarily represent the FFF’s opinions. They also are not political statements – this is an arena for people to share their thoughts and feelings, and I hope we can all give them the space to do so. 


I got another one last week. One of those messages. The ones that make me feel like I am totally failing to impart my message correctly; the ones that make me question my own inner bias. The message was from a mom saying she didn’t feel supported on this site because she had chosen formula from the get-go. And as I’ve said many times before, I get that. I seriously do. I can give you every reason in the book for why these FFF Fridays tend towards a certain storyline (the main one being that people who feel 100% confident and happy with a choice to formula feed don’t tend to feel inspired to write cathartic stories about infant feeding struggles), but it’s not going to stop you from feeling unsupported.

I can tell you until my face turns blue that I support those who choose to formula feed from day one just as much as I support those who tried until they fell apart, physically and/or emotionally. But I know that doesn’t always come across on my Facebook page, or in my posts. I think that is partly due to my own experience; I think breastfeeding is one of the coolest things ever. I wish I could have done it. Sometimes I have crazy thoughts about having another baby just so I could try, one last time (don’t worry, Fearless Husband, if you are reading this – I’m not that crazy). When I see some of you who came to me as FFFs now happily nursing second or third children, I feel utter joy for you, but I still feel a faint but unmistakably ugly pang of envy that I didn’t have that experience, that my depression had to be so inexplicably tied to lactating; that my nerves were misfiring in such a way that made breastfeeding about as fun as water boarding. 

It is hard to admit these things, because they are emotions, and emotions don’t always match analytical thoughts, and I’d hate for anyone to misunderstand my intellectual take on these issues. For me, it is not so much about breastfeeding or formula feeding; it is about respecting women’s bodily autonomy, and their lived realities, and also about respecting logic, analysis and the truth of statistics. It’s about respecting YOUR experience. I want to honor every single one of your stories, but in doing so, I can’t always make an editorial choice to change up the narrative so that it ensures a wider audience is served. 

I’m not sure where I’m going with this… I guess it’s one more attempt at an explanation for why so many of these stories start out with “I always wanted to breastfeed…” because it’s the people who are in tears, bleeding through their nursing bras, who seek me out in the wee hours of the night. It’s not typically women like Lynn who submit stories, but I wish I would get more of these (and I’m so glad she sent hers in), because they are just as worthwhile, and just as important. And speaking of analytical thoughts…. I have to say that I am in awe of Lynn’s ability to consider this typically emotional issue so clearly and thoughtfully, with thought being the operative word. I wish I could know this girl in real life because she’d make one hell of a sounding board for big decisions.  

Happy Friday, fearless ones,



Lynn’s Story 

This isn’t a post about how I tried to breastfeed my children and failed. This isn’t a post about how I tried to breastfeed my children and succeeded. This is a post about why I chose to feed my children formula, and why I have no regrets about my choice, regardless of the comments and criticisms I recieve.

A little more then three years ago I found out I was pregnant with my first son. It was an amazing feeling. I loved sharing the news with friends and family and I couldn’t wait to meet the little bean growing inside me. At about 20 weeks I had my first appointment with my OB. They asked me if I planned to breastfeed. I hadn’t really given much thought at this point to how I was going to feed my child and told this to the nurse. She told me she would give me some information and I could let her know what I decided at my next appointment. Sounded good to me. So when we got home I decided to go through the information the nurse had given me and decide what was right for us. (At this time I thought the choice was all mine, you know, since the nurse told me to let her know what I decided… but we’ll get to that) Going through the information I realized that all the pamphets were titled things like ’10 reasons breast is best’ ‘Positions for Breastfeeding’ ‘Breastfeeding and Bonding with your baby’ It was all so onesided. There was no information on formula. At all.

So I asked my mom what she did. She breastfed all but one of her children. The one of my siblings she couldn’t breastfeed was born with a cleft lip and palate and was tube fed. She tried pumping for awhile, but only had a manual pump and couldn’t keep up with a 2 yr old and a newborn at home so she switched to formula. She had no issues, no struggles. Breastfeeding was 100% natural for her.

Then I asked my husbands dad what they did. They formula fed all of their children. All of us (my husband and I and our siblings) are healthy, and looking at all of us, there didn’t seem to be a huge difference either way.

So out came Google. I searched breastfeeding and sids, I searched bonding, I searched a million and one things and was loaded down with information about why breast is best and got next to nothing on formula. So my husband and I sat down and talked. And talked and talked and talked about what was best for us.

When we discussed bonding, we decided that since he was taking parental to be home with me and the baby, he wanted to be able to help with feedings. Formula feeding got the benefit there. I have heard the arguement that dad’s can bond with their babies at other times then feeding, and that pumping was an option that would have allowed me to still breastfeed. And those people are right. But it wasn’t right for us.

Then we needed to take into consideration how the elephant in the room (my anxieties) felt about our choices. The anxious part of me felt that I had enough defiencies in my diet, that how could I possibly know that my baby was getting everything he needed from my milk? The arguement that my body would make sure he was didn’t soothe me. How would it possibly make me feel better that my body would take away from me to make sure the baby was healthy? Then I am going to be unhealthy and then how is that going to affect the baby? Formula won out on that arguement too. When I give the baby the bottle, I know exactly how much he is drinking, and what is in it.

We also took into consideration the cost. We didn’t have a lot of extra money, but we made up a good budget and figured out that we could indeed afford to formula feed, if that was our final choice.

Since I was still wavering a little bit in my choice, I decided that I was going to ask a few friends who had babies what they had chosen and why they went that route. Friend 1 told me she chose to breast feed. It  worked out great for her and she breastfed for 3 months until her and her baby’s daddy went their seperate ways then she chose to switch to formula so the baby could have time with his daddy without needing to worry about feedings. I asked her why she chose to breastfeed (not to judge, but just in case there was something I was missing) She gave me 3 reasons. 1- it was cheaper 2- it reduces the risk of sids 3- to help her lose the baby weight faster. Friend 2 told me she had chosen to breastfeed but only breastfed for a couple weeks before she switched to formula because it was really hard on her with a c section and her baby wasn’t gaining any weight. I asked her as well why she chose to breast feed and was told 1- it was cheaper and 2- to help her lose the weight faster.

That gave me 2 more reasons to consider. Reduces the risk of sids…. I looked into that. And found the actual study that proved this. I don’t have it handy, but I do remember that it only reduced the risk by about 0.002% or some similar small number. As for losing the weight faster… to me this seemed like one less reason to breastfeed. When you are breastfeeding you need to get an extra 500 calories, I don’t have an appitite when I am tired and I get sick if I force myself to eat. Having a newborn seems to equate to being tired, and being tired (for me) equals not eating… so what exactly am I feeding my newborn if I choose to breastfeed?

This led me to my choice. Fast forward to my next OB appointment. Again the nurse asks me if I am going to be breastfeeding the baby. This time I confidently reply with ‘No. We have chosen to formula feed’ She didn’t say anything negative about it. She smiled at me and told me she would get me some pamphlets on my way out. I smiled and said Ok. When I got home and went into the envelop she had given me, expecting to find some tips on formula, I found more information on breastfeeding… Being naive, I assumed I must have been given an envelope meant for someone else and let it go. When I went back into the Dr’s office for my next appointment, I mentioned to the nurse that I was given more breastfeeding information and I wondered if I could get any information on formulas. I was told that they didn’t have any information about formula types. All she could tell me was what the hospital used. What a royal pain it was, to get anyone to answer any questions I had about formula.

Eventually I went into labor, and I was very glad that the nurse I had when I had my son was very non judgemental when I told her that I wanted to formula feed. She made sure that I was given formula and took the time to explain to me how much my baby needed to eat, and how often to feed him. She talked to me about feeding on demand, and what signs to watch for for allergies and over feeding.

After leaving the hospital, my son gained weight, grew and at each appointment with our family Dr we were told how great he was growing, and how healthy he was. That made it easy to ignore the people who told us that we were overfeeding him, that formula makes fat babies and how we were poisoning him. When I got pregnant with my second and third children, we automatically went to formula. With each pregnancy people would ask me if I planned to breastfeed my baby, and I replied with a simple no. Of course they always looked shocked and would ask why I wasn’t even trying. Not that it was anyones business, but I had no issue explaining that we formula fed our first and it worked so well for him it just made sense to do the same thing with any additional children, unless it proved not to work. (This extended to all of our parenting choices, not just the feeding issue)

I don’t regret choosing to feed my children formula rather then breastmilk. I don’t feel as though they or I missed out on some cosmic bond that only breastfed babies can have with their moms. I know I did the best thing I could for them and for me.

Today I have 3 healthy children. Alex is 2.5 years old, he is 37 inches tall and weighs 31 pounds. Nick is 16 months old, he is 32 inches tall and weights 26 pounds. Zoey is 2 months old, she is 23 inches tall and weighs 12 pounds. None of my children are obese. None of my children are constantly sick.

It makes me sad that people feel the need to justify their choices. There is no right or wrong when it comes to breastfeeding or formula feeding or doing a combination of both. What is important is that you are listening to your childs needs and meeting them to the best of your ability. As moms we need to support one anothers choices. Formula feeding shouldn’t only be okay for moms who weren’t able to breastfeed. Formula feeding should be okay for all moms. Breastfeeding moms shouldn’t be shamed for feeding their children in public. Formula feeding mom’s shouldn’t be shamed for using something that didn’t come from their breast to feed their child. No one should be judged. No one should be criticized.

I hope that by sharing my story, and my reasons, more moms will feel better about their choices and not feel pressured into feeding their child one way over another just because society says its better. How can formula be perfectly healthy and okay for children when the mom was medically unable to breastfeed, but poison for children when the mom chose not to breastfeed?


Share your story for an upcoming FFF Friday – whatever that story may be. Email it to me at 

City of Ottawa Public Health Unit’s “Informed Consent” webpage: A case study in (un)informed consent

An anonymous FFF reader has allowed me to publish the following letter, which she sent to her local Public Health unit in Ottawa. I visited the site that caused her so much consternation, and I was equally incensed. Please click here to see what she and I are talking about:

Make an informed decision about feeding your baby

My thoughts on the Ottawa website follow this letter. I’d also encourage you to check out the letter sent by the blogger at Awaiting Juno. And, if you’re feeling inspired to do so and happen to be a citizen of Ottawa (or even if you just feel like giving them your opinion), feel free to write your own letter and send it to


Dear City of Ottawa Public Health Unit,

I discovered the following webpage on Informed Consent and was utterly dismayed at what I had read.

I had my daughter seven years ago and am hoping to have another child within the next two years. When I was pregnant with her I knew I was going to breastfeed her. I felt that formula was vastly inferior. Unfortunately having breast hypoplasia (something that none of the literature of had prepared me for), made exclusive breastfeeding an impossibility. My daughter went from losing weight on my breasts alone (I did have a postpartum nurse who was very concerned about my breasts due to their shape and spacing, but I dismissed it as an unsupportive nurse, not as her giving me relevant information on my situation), to thriving on formula.

That page isn’t giving informed consent, it is scaring women into breastfeeding by bringing up scary words like “obesity”, “SIDS” and “Cancer”, without mentioning any potential  drawbacks for breastfeeding (including not being able to take certain medication and that it can be a physically and emotionally draining experience for some) and without making any positives about formula. It also doesn’t mention that formula prepared properly is a valid feeding method and choosing it doesn’t mean that a child will end up toothless, obese, diagnosed with cancer, or dead. From what I have seen about the research the main risks are a higher rate of gastrointestinal viruses and ear infections (which my daughter did get, when she was 5 and a half years old). For a woman who might be already sad that breastfeeding isn’t working out with them, such phrasing of information without perspective or actual risk amounts could contribute to postpartum depression. I should know- seeing that kind of information online (it exists all over the internet) after switching to formula was a contributing factor to my own depression.

You mention on the first page that the Baby Friendly designation includes supporting women’s feeding choices, but I do not see how that supports a formula feeding woman at all and could increase the stigma and isolation about using a product that is in fact very safe to use in our city.

I encourage you to take that “Informed Consent” page down and rework it so that it does not demonize formula. The benefits of breastfeeding in all honestly should be able to stand on its own without resorting to demonizing formula. Furthermore, I am more than willing to help with any rewording to help formula feeding moms feel more supported in their choice.

As a taxpayer, mother and a woman who felt intense guilt for 2 years for using a product that nourished my daughter where I couldn’t (I also have the perspective that she is a very healthy, active 7 year old), I urge you to reconsider your approach.

Yours truly,



Before I return to my Pad See-Ew, which is currently getting cold (yet another reason to be annoyed at the city of Ottawa – they are ruining my damn dinner), I want to add a few of my own thoughts to Anonymous’s letter.

The document on the Ottawa Dept. of Health website is coercive and factually inaccurate, starting with the first sentence. They state:

Deciding how you are going to feed your baby is one of the most important decisions you will make as a parent.

What the “most important decisions” you’ll make as a parent are is entirely subjective.

Next, they state:

Making an informed decision means you have all of the information you need to help you decide what is best for your family.

Yep. Exactly. You deserve accurate, dispassionate information so that YOU can decide what is best for YOUR family. This document does the polar opposite. It confuses correlation and causation (I only see two uses of the important qualifier “may” in the lists of benefits and risks – for example, they claim that breastfeeding “helps to protect against cancer of the breast and ovary.” It would be accurate to say that breastfeeding “may help to protect…” or “has been associated with a lower risk of…”, but the way they pronounce this benefit makes it sound proven without a doubt. This is simply not true); it does not mention any of the potential downsides of breastfeeding, nor the benefits of formula feeding (even if they’d just said “the ability to feed your child when breastfeeding isn’t working or there isn’t a mom in the picture”, it would have sufficed); and most importantly, it does not leave the reader with any choice other than to breastfeed, or feel like an inadequate, terrible human being. And before someone starts misquoting Eleanor Roosevelt to me, let me stop you: yes, people CAN make you feel guilty without your consent. Or if you can’t agree with me on that, let’s forget about guilt – how about embarrassed or judged? Can people make you feel that way without your consent? And what if you’re not in any emotional place to give that consent? Like when you are a hormonal pregnant or newly postpartum parent, and it’s your city government posting a bunch of fear-inducing drivel under the headline “the benefits or breastfeeding for the baby, mother, family and the community”? How about then?

The document’s piece de resistance is this half-assed suggestion at the bottom of the page:

If you have made the informed decision to formula feed and need information on how to prepare it safely, please visit Ottawa Public Health’s Food safety page.

Ah, I see. So if you’ve made a decision to do something that causes nothing but inconvenience, pain, and suffering for you and your child (and your community- can’t forfet your community!) based on this “information”, you should just go to a different department, because we’re freaking OVER you. Notice that when the link for more information on breastfeeding follows this taxonomy:

Residents>>Public health>>Pregnancy and babies>>Healthy baby and parenting>>Feeding your baby>>Breastfeeding

There is NOTHING about formula in this “Feeding your baby” section. Instead, formula feeding monsters, er, mothers are directed to:

Residents>>Public health>>Food safety and inspections>>Baby Formula

Apparently, healthy babies and parenting only has to do with breastfeeding. Formula feeding is on par with selling hot dogs at softball games.

I don’t even know what to say, except to all the soon-to-be moms and currently formula-feeding or combo-feeding mothers in Ottawa, I am so, so sorry. Your city health department sucks donkey balls. And if I were you, I’d start the angry tweets and emails right. Freaking. NOW.

Twitter: @ottawacity




Is donor milk dangerous? Not as dangerous as hypocrisy.

Those of you who have been reading this blog long enough are probably well aware that I hate hypocrisy. I mean, I hate it. I hate it in politics, I hate it in religion, I hate it in the spats I have with Fearless Husband, and of course, I hate it in the breastfeeding/formula feeding debate.

But most of all, I hate it in myself.

That’s why I’m sitting here agonizing over how to report on a study that hit the news cycle tonight. According to NBC News,

…a new study finds that human milk bought and sold on the Internet may be contaminated — and dangerous…Nearly 75 percent of breast milk bought through the site was tainted with high levels of disease-causing bacteria, including germs found in human waste…That’s according to Sarah A. Keim, a researcher at Nationwide Children’s Hospital in Columbus, Ohio, where her team purchased more than 100 samples of human milk last year, compared them to unpasteurized samples donated to a milk bank and then tested them for safety…what the researchers found was worrisome: more colonies of Gram-negative bacteria including coliform, staphylococcus and streptococcus bacteria in the milk purchased online, and, in about 20 percent of samples, cytomegalovirus, or CMV, which can cause serious illness in premature or sick babies. The contamination was associated with poor milk collection, storage or shipping practices, the analysis showed.

Here’s the problem: I look at articles which report on the dangers of formula with an intensely critical eye. It would be horrendously hypocritical for me not to do the same in this case – and I’m especially worried, because the people purchasing donor milk are in the same boat as many FFFs – people who wanted to breastfeed and couldn’t. I don’t want to turn my back on my audience and be a hypocrite in one fell swoop.

And yet.

Obtaining milk online is a new construct. We do not have several generations of humans raised on donor milk to examine and rely on for (admittedly insufficient, but oddly comforting) anecdata. We can’t define “donor milk” as clearly as we define commercial formula, because it isn’t a static product. Formula does not change based on a baby’s needs and age, or based on the diet or environment of the woman producing it; breastmilk does. There is not the issue of online, anonymous dealings when we discuss formula (well, unless you count the 16 cans of Alimentum my husband purchased on Ebay…I know, I know, but it was sealed. And that shit’s expensive if you buy it retail).

Discussing donor milk and the safety thereof is not the same as discussing formula, because there are so many more issues at play. This study is not about whether donor milk can nourish an infant better than formula can. This is about the biology of a live substance, and what happens to that substance once it leaves one person’s body and is transported to another’s. This is about body politics, and e-commerce. It is so much more complex than breast versus bottle.

So I hope I’m not being hypocritical when I look favorably at this study, because I do think it’s one worth taking seriously, as long as we acknowledge the limitations. Let’s review those, first:

1. It was a singular study. ONE study. Which used donor milk from one specific organization.

2. As the study is not yet available online, there’s still a lot we don’t know. NBC reports, “Of the 101 samples analyzed, 72 were contaminated with bacteria and would not have met criteria for feeding without pasteurization set by the Human Milk Banking Association of North America, or HMBANA.” I’m not sure how these criteria are set by HMBANA, and I don’t know exactly what the dangers of these bacteria are.

3. We don’t know that any of the babies who would have received this milk would necessarily have gotten sick. (This is one of the things we discuss with formula feeding studies, remember? For example, many people worry about the GMOs in formula. And yeah, most formulas contain ingredients derived from genetically modified corn, soy, and other foodstuffs.  But we have no evidence that babies fed these formulas suffer any ill effects from these tiny amounts of GMOs.)

Now, let’s talk about why this study is a little different than most of the breastmilk vs. formula studies we encounter.

1. The results were in vitro – aka, found in a lab. These were not observational or self-reported or marred by recollection bias. These were findings that were discovered from looking at samples under a microscope, in a controlled environment.

2. We do know that some of these bacteria are dangerous to babies.  20 % of the collected donor milk samples contained cytomegalovirus, which according to NBC “can cause serious illness in premature or sick babies.” 20% is a substantial amount.  The article didn’t give numbers for the samples which contained other disease-causing bacteria like coliform and staphylococcus, nor do we know if the amount of bacteria was sufficient to cause illness. (Please note: I think we do need to approach this with caution until we see more information, because there’s a chance the amount of bacteria wasn’t clinically significant.)

3. A large part of my ennui with formula studies is that most tell us the same thing: breastfeeding mothers are associated with healthier children. There’s not much variance in the theme of the research, or what can be done about it. This study is nothing like that. It is giving us actual information about the actual risk of bacterial contamination through donor milk. This is exactly why I started taking formula preparation rules so seriously when I saw in vitro studies on bacteria found in infant formula. It’s hard to argue with cold, hard science that has removed the human condition from the equation.

More importantly, this study offers us an opportunity. Not only does it allow us to improve milk sharing – something that can and should be a choice for moms who cannot or choose not to breastfeed – it reminds us that cold, hard science can be translated into better feeding options for families. Donor milk can and should be tested, to see how it needs to be stored and transported and screened. Formula can be compared with donor milk so that parents can understand the risks and benefits to both scenarios. Since one of the advantages of breastmilk is its ever-changing, adaptive personality, we could look at how the donor milk from a mom nursing a toddler might affect a newborn. We could even see if, say, the milk from women with higher IQs equates to higher IQs in babies fed their donor milk (oy, can you imagine the eugenic excitement over a finding like that? ::shudder::). You see where I’m going with this. When we’re discussing the substance rather than the behavior, a whole world of research will open up – research that can ultimately lead to improved formula, improved donor milk, and improved options for both babies and parents.

Lastly, it seems that defensiveness about negative press for one’s feeding choice is not exclusive to formula feeders. NBC quotes one milk sharing network’s founder as accusing the research of being “A blatant attack on women attempting to feed their babies”:

“..(It) is cruel and you should feel ashamed of yourself for spreading misinformation,” Khadijah Cisse, a midwife who founded MilkShare, a portal for connecting women cited in the new research, said in an email to NBC News. “Anyone can type up any bit of lies they want and make claims. Breast milk is supposed to contain bacteria.”

I feel bad for Cisse, as I know what it feels like to read research that denies my own lived experiences, or makes me feel judged for feeding my child in a specific manner. In her defense (and mine), it’s really hard to keep a lid on one’s anger when the media takes a 5k story and runs a marathon with it, without any consideration for context or nuance.

Imagine how much easier it would be to keep that proverbial lid tightly locked, if feeding choices were supported and respected. If the dialogue didn’t always involve universal bests. If we could make choices armed with more cold, hard science so that the choices themselves didn’t have to so damn cold and hard.

There’s a lot we could learn from this study.

Or, you know. It could die in an avalanche of hypocrisy.







Getting a grip on the Strong Mom Empowerment Pledge Controversy

The latest outrage in the breastfeeding advocacy world doesn’t have to do with dying children in resource poor nations, or bogus “breastfeeding advice” hotlines run with the nefarious goal of undermining a mother’s goals. It’s not even about someone questioning the benefits of breastfeeding, or urging the government to rethink some of its public health messaging.

No, this week’s rage-fest is over a campaign asking women to pledge not to bully one another based on their parenting choices.

Sound silly? Well, according to a handful of well-respected bloggers, it’s about as silly as a car wreck. This is because the campaign is sponsored by Similac, a formula company, which has everything to gain by women feeling “empowered” to use their second-best (or fourth best, if we’re going by the WHO hierarchy) product in a world made less judgmental by a pledge such as this.

On a purely anti-capitalist, anti-marketing level , I understand why some may feel a little queasy about this campaign. I’ve seen some backlash against the Dove Real Beauty ads for the same reason – the message is great, but the fact that it was created by a group of advertising executives rather than a non-profit, purely altruistic group, sullies it. There’s an ad term for what Dove and Similac are doing – the “halo effect” – meaning that when you use the product, you’ll have positive, do-gooder type feelings about it. Coke’s done it, too. (Remember that catchy “I’d like to teach the world to sing” jingle? Halo effect, right there.)

I assume this is what was behind tweets I came across today suggesting that formula companies have no place talking about parenting issues. My counter argument to this is that many of us formula feeders feel abandoned by the parenting gurus (paging Dr. Sears) and in some cases, even our own pediatricians – the message we receive is that if we’re formula feeding, we’re pretty much a lost cause. So while I can’t say I’m thrilled that a formula company stepped up to fill this gap, I think we need to think a little more critically about why the gap was there in the first place.

For the record, with this particular campaign, Similac isn’t giving parenting advice, but rather advocating for an end to mother-to-mother judgment. More of an anti-bullying campaign than anything about parenting issues. Which is probably why they have Michele Borba as one of the spokespeople – she’s a well-known expert on bullying as well as parenting issues, but she barely deals with the infant/toddler set. For that matter, I don’t think babies are mentioned at all in the campaign literature –most of it has to do with embracing your parenting choices and not allowing other people to make you feel less-than.

But I’m not even all that interested in discussing the campaign itself – I’m more concerned with the response to it. Comments I’ve seen; articles I’ve read from some folks I have utmost respect for, but whom I feel really missed the mark on this one. Some of these arguments include: Similac has no right to talk about mommy judgment because formula feeding shouldn’t be a lifestyle choice; the bloggers who came on board to support the campaign are sell-outs or shills for Big Forma; and that the campaign is one big booby trap.

In a thought-provoking and controversial NY Times Motherlode column, KJ Dell’Antonia quotes Kimberly Sears Allers, who maintains that the Strong Moms Empowerment campaign is faulty because formula feeding is a public health issue, not a personal choice:

One centimeter beneath the surface of Similac’s “Strong Moms” Summit and online campaign you will find that framing of infant formula use as a “lifestyle choice” that is not to be judged has been its primary marketing strategy for decades. … And since choices are individual, they have no social consequences; women are therefore relieved of responsibility of considering the broader implications of their decisions. And once I make my choice, no one is to challenge me. We can’t talk about it. And if you do, you are judging me.

Admittedly, I’m taking major poetic license here, but my take-away from Allers’ post was that we can’t not judge other moms for doing something which puts babies at risk. KJ’s own argument is more nuanced and balanced; she suggests that this whole conversation has become too personal, and the “judgment” rhetoric just dilutes the real issues.

I agree with KJ, actually – it’s a point I’ve made myself, in my own somewhat pissy rants about how the only anti-breastfeeding-promotion opinions we hear come in the form of personal stories (which are important in their own right – don’t get me wrong – but hardly a match against scientific studies and “fact”-driven articles). But making things “less personal” doesn’t just mean that every blog post discussing breastfeeding must stop devolving into a who-had-it-harder string of comments. The onus can’t purely be on those whose choices are being questioned to buck up and be “strong”. If we’re going to make it less personal, than breastfeeding advocates cannot be in charge of conducting research on infant feeding. We need to ensure that voices from both sides are heard, so that formula feeding mothers don’t need to sit in awkward, shameful silence while the food that so beautifully nourishes their infants is compared to tobacco, lest they be accused of “taking things so personally”.  And outlets like the New York Times need to post intellectually-driven or research-based pieces from the “other” perspective, rather than just personal stories of breastfeeding failure, so that the conversation isn’t so one-sided.

But I think, in some ways, KJ’s point gets convoluted by Allers’ quote. It can’t not be personal, when a woman’s decision to formula feed is being equated to a public health issue. This is where the misinterpretation of risk within the breastfeeding canon is problematic; it is where people like Joan Wolf are so vitally important. And yet, Joan Wolf can’t participate in the conversation because it has become so personal: her assessment of the literature is brushed off as anti-breastfeeding, lost in the fervor of those who fear that discussing breastmilk as anything less than a miraculous and perfect substance, and breastfeeding as anything less than a moral imperative, will negate their admirable efforts to normalize what should be a human right.

The other common refrain in the past few days is that formula feeding mothers should be offended by this campaign. I’m crying foul. First of all, I take issue with breastfeeding advocates speaking for me – someone who felt completely ousted, chastised, and disenfranchised from their community, and their ideal of good mothering. Just like I will never know the hot rage felt by a nursing mom who is asked to leave a restaurant, someone who has a fundamental belief that breast is best will never know what it feels like to be told that your maternal instinct is faulty, due to susceptibility to marketing, stupidity, selfishness, or some combination of the three.  To hear a company which created a product that nurtured my babies echoing the same sentiments I’ve been preaching for years – that the judgment must stop; that moms need to stop fighting each other and work together for better parenting rights; that women need to stop engaging in sorority-level hazing in order to wear the label of “Good Mommy/Good Radical Feminist/Strong Woman – makes me happy. I don’t feel preyed upon; I am well aware that they are hoping to sell more formula, and you know what? If I had to decide between a brand that is marketing to breastfeeding moms and one that is finally trying to appeal to its actual audience, I’d probably choose the latter.

Someone commented on the NYT article that it would’ve been nice if this campaign came from an individual or group without profit-driven motives. Spoiler alert: that would be me. That would be Bottle Babies. We’re out there, doing this. But most people aren’t aware of us – we each top out at about 3k Facebook followers, opposed to the popular breastfeeding blogger-activists, who are all in the 200k range or higher (some of whom, incidentally, could benefit from a pledge not to bully other moms. Just sayin’.)  We have nothing behind us – no advertising, no sponsors. No money. It’s slow going, trying to make a dent, attempting to create change in a positive and real and measured way. We waste a lot of time defending ourselves against accusations of working for the formula companies; of being anti-breastfeeding; of being uninformed and defensive.  And trying to run our ad-free websites and blogs and attend conference on our own dime and BE HEARD when there are so many more powerful, louder people out there. I realize this sounds like a whiny me-me-me rant, but I’m trying to paint a picture here – because it helps explains why I’m okay with the Similac campaign. Until the indie, unsponsored voices are able to reach the masses, I’m just happy that someone can. I’m happy that women who are feeling judged and guilty and embarrassed about their choices, who are forced to read “Breast is Best” every time they see a formula ad, or open a can of food for their baby, can finally have an opportunity to feel good about the product they are using. That for once, we can feel like part of the sorority – part of the “empowered” group – even if it’s all manufactured and for profit, even if it’s bullshit.  It’s not even about the cheesy “empowerment” pledge – it’s about seeing a formula company treat formula feeding as something matter-a-fact, rather than constantly comparing itself to breastmilk, and in a more subtle and unintentional way, comparing formula feeding mothers to breastfeeding mothers. It’s about being able to feel okay about the way a formula company is operating, rather than cringing at how they are sending free samples to moms intending on breastfeeding (rather than those of us who’ve filled out the damn internet form 300 times and never received a single coupon, but I digress) or marketing some asinine product (like the company in question, with its new “formula for supplementation”. Jesus, Similac. I’m wasting time defending you and then you pull something like this? For real?)

Yes, it’s not perfect. But it’s a start. And if you think it’s sad that we are so desperate for acceptance and celebration that we are willing to get into bed with a formula company that thinks of us like an easy booty call, I’d recommend taking a long, hard look at yourself: at the comments you make; the Facebook posts you share; the policies you write; the initiatives you implement; the articles you publish.

Because yes, it is sad. It is sad that Similac has been able to capitalize on this need. It is sad that there is the need to capitalize on. And it’s sad that those who have created that need are refusing to see how implicit they are in the development of such a sad situation.

It’s just sad.


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