We talk a lot in the Fearless Formula Feeder community about the negative experiences we’ve had with medical professionals, media outlets, and our peers. And this is good, and healthy – we need a place to chew on these bitter feelings, and hopefully digest them so we can move on with our lives. Still, I want to go a step further this year, and really think about (and act upon) what could be made better. I think the time for some positive, real change is now, don’t you?
Considering how much the infant feeding world likes research, I think some data is a good place to start. Mind you, what I’m about to talk about isn’t peer reviewed or even professional compiled data; it’s merely a Survey Monkey study, which any Joe Shmoe can do at any time. This one was written by me, and I am by no means an epidemiologist (although I like to pretend I am, and probably would have tried to be if I could wrap my mind around simple algebra, let alone statistics) or PhD or anything of the sort. So it’s important to take this data with a grain of salt; it’s simply anecdotal, self-reported data crunched by a website to give us some idea of what’s going on for a particular, self-selected group.
Let’s talk a little about what this all means. Basically, I posted this site on the FFF Facebook page. It was shared and spread around a fair amount, but it’s safe to say that the majority of the respondents were FFF members. Which means something, because as a group, we tend to be a few things: educated, interested in parenting, mostly white, mostly lower-middle to middle class, mostly English-speaking (although the respondents included people from the U.S., Canada, the UK, France, United Arab Emirates, Australia, New Zealand, the Netherlands, Bulgaria, South Africa, Russia, and Mexico), and people who read a lot and care a lot about formula feeding issues. Because of this, we can’t necessarily assume that our experiences are typical of ALL formula feeding parents, but considering we have a pool of 1120 people, from a variety of geographic areas who formula feed for a number of different reasons, we can infer some things from the data we have here.
That said, I think it’s interesting and helpful to at least collect our experiences in a way that can help us talk about them more clinically, to understand the experience of some formula feeders, who tend to be parents who think a lot about parenting. That’s important, I think, because it suggests that these answers are relevant for care providers who are trying to serve this market.
With no further qualifications and hemming and hawing, I’d like to present you with the results of the first ever Fearless Formula Feeder/I Support You Survey on Formula Feeding Experiences.
Question 1: When did you begin formula feeding?
The majority (32%) of respondents began using at least some formula shortly after birth, although breastfed at least once. But those who began using formula after one month were a close second, at 25%, and 19% formula fed from birth.
Real-world implications: If most of these respondents were formula feeding a one-month infant or younger, their responses on the degree of instruction they received carry particular relevance. In completely unscientific terms – we’re talking about tiny babies and brand new, very sleep deprived parents. If anyone needs explicit guidance on something which can, at times, resemble a junior high chemistry experiment, it’s these folks.
Question 2: What were your reasons for choosing formula?
Respondents were able to select more than one answer here, so please note that there was often a combination of reasons that led an individual parent to formula feed. The most common answers were “I couldn’t produce enough milk” (44%); “My child wasn’t able to breastfeed successfully” (33%); and “Breastfeeding contributed to my postpartum depression” (22%). 17% of respondents chose “I did not want to breastfeed.” As respondents could elaborate on their reasons via a text box, some of the comments received were as follows:
“I am a survivor of childhood sexual abuse, and both childbirth and breastfeeding were intensely triggering.”
“I stopped because it was straining my mental health and I felt like I was missing my daughter’s life because I was so consumed with trying to make breastfeeding work.”
“When they tested my milk with my 2nd child (32 weeker preemie) it was as fatty and nutritious as tap water.”
“Doing all of the nightfeeds by myself was never a realistic option for our family because I earn most of our income, I can’t show up to work massively sleep deprived and I have no opportunity to pump during the workday. This little detail was glossed over in all our prenatal breastfeeding education. When I caught on to it in the first week postpartum my husband and I jointly decided that breastfeeding was not for us.”
“I had mastitis so severe I was hospitalized. It turned into an abscess that they tried 3 times to drain with a needle but it didn’t work. They eventually had to do surgery to remove it. I tried to breastfeed through all that up until the second time they tried to drain it with a needle when I finally decided to stop trying because it was killing me.”
“Child ended up hospitalized due to dehydration.”
“I had postpartum thyroiditis. Only ever… produce(d) 2 ounces of milk per day. It also triggered devastating insomnia that lasted for 12 days. I decided it was killing me, so i stopped.”
Real-world implications: The responses on this question are obviously all self-reported, and there’s no way to verify the validity of medical reasons such as an inability to produce milk. However, I’m in the business of believing moms when they tell me things, so I’m assuming that there was a valid reason each of these moms felt that breastfeeding did not work for them. The point of including this question, for my purposes, was to see the variety of reasons parents chose formula and to get an idea of what would be best discussed prenatally. For example, there are visual cues for Insufficient Glandular Tissue, which physicians could be trained to notice during prenatal exams. Or, for women with histories of depression or sexual trauma, it might be helpful to be more open about the effect breastfeeding may have on them in an individualized, sensitive way – because what is empowering and healing for one woman might be damaging and re-traumatizing to another.
Question 3: When you first began formula feeding, were you given instruction/guidance from medical/hospital staff?
55% of respondents said that were not given any formal instruction or guidance on how to use formula. While 33% of the rest of the group did get some sort of verbal guidance from a medical professional, only 12% got a pamphlet or written material.
Real-world implications: This seems like a no-brainer – how hard is it, really, to give new parents a brief one-sheet on formula prep, with resources listed for further help?
This leads me to….
Question 4: Where did you receive most of your guidance on using formula?
53% – just over half- said that the main source of instruction was from the back of a formula can.
Parents are also getting help from other sources – nearly 30% did cite their pediatrician/other medical professional as a resource, so that’s promising. Another 33% said that websites were helpful, and 23% got assistance from friends or relatives.
Real-world implications: Considering pediatricians typically give verbal or written instructions on how to administer baby ibuprofen, and discuss things like television use, potty training, and sleep training with patients, I think it’s odd that we assume the instructions written on the back of a can are sufficient for safe formula prep. Not all parents are native English speakers or fully literate. Not all parents can read tiny print on the back of a can at 2am, when they are sleep deprived and worried about a newborn.
Question 5: Do you feel you received adequate information about formula feeding safety and use?
While 40% said yes, 34% said “no” and another 22% said “I’m not sure”.
Real-world implications: This suggests more than half of parents using formula aren’t convinced that they were given enough information to feed their babies safely. Not acceptable.
Some additional responses:
“Too many people I spoke to IRL seemed to be compelled to remind me that breast was best. That shaming did not help me during a time when I was very vulnerable and wanted information”
“Eventually, after I did my own research. The nurse in the hospital almost yelled at us for leaving the half consumed bottle of ready-to-feed out at room temperature. We had no idea as new parents what we were supposed to do with formula, and no one had taken the time to explain it to us. So any information I got was from my own research.”
“I feel I had to ask too many questions to the pediatrician that should have just been told to me. For example, in the hospital they gave him 2oz every 4 hrs. When we went home no one told us to change that so he dropped a lot of weight…”
Question 6: If you could choose the way you received info on formula, how would you like it to be given?
Respondents could choose more than one answer here, but there were two methods which received the vast majority of responses: “a nurse or doctor to talk to you about it” and “a pamphlet or written materials.”
Real world implications: Medical professionals need to be informed on formula feeding safety and practicalities, and be allowed to impart the information in a judgment-free manner. Written materials should also be created to be given to parents at discharge. Since 18% and 16% responded that they’d like to learn about formula via a peer support group or websites/books respectively, it also may be helpful to offer a resource list to all expectant mothers that is truly comprehensive, and not just helpful for those planning to breastfeed.
Question 7: What was the hardest thing you faced when you began using formula?
This was one of the most interesting questions on the survey, in my opinion; 65% of parents responded that “my own feelings about formula use (guilt, shame, fear, etc.)” was the hardest aspect. The other two popular answers were “the lack of social/emotional support from fellow parents” and “the lack of information on safety, choosing a formula, bottle feeding, etc. (practical issues).”
Real-world implications: Formula feeding parents need a safe space where they can access peer support, work through feeling of guilt/shame/fear, and learn about practical issues of formula feeding. To me, the simplest answer is that we need peer support groups, our own version of La Leche League. Kim Simon and I have been developing a platform for these peer groups through the I Support You organization, and I am really excited that two FFF members have already started their own local chapters (Atlanta and Baltimore). I hope that we can grow this movement so that every major metropolitan area has a resource for formula feeding/combo feeding parents, because as these numbers show, it is desperately needed. Need more proof? Here are some of the open-ended responses to this question:
“I became very depressed and felt worthless as a mother and human being. Luckily, my husband caught me in the middle of writing a good bye letter to my daughter as I had planned to end my life.”
“felt like a failure for not giving the “liquid gold.” I really had to search for good evidence. I remember finding a paper by 3 biostatisticians who had all breastfed. They dug into the evidence. Reduced mortalitly? One study had one infant death in the formula fed group, but the baby fell off the counter!!! Finding unbiased, easily accessible info would have been great. “
“The NICU lacation consultants were relentless. My doctor told me that I most likely would not be able to successfully pump. The NICU nurses understood that it didn’t work out. My baby’s doctor made arrangements for donor milk. However, the lactation consultants hounded me and made me feel like it was my fault it wasn’t working. They added unnecessary stress to a situation that was already a nightmare.”
“I didn’t know any other formula feeders. It wasn’t that my fiends/peers were unsupportive… but they were all breastfeeding and could not relate to formula feeding.”
Question 8: Did you have any trouble with the technical aspects of formula feeding?
43% of respondents said no, they hadn’t had any issues in this regard. Of the remaining respondents, the most commonly-faced issue was reflux/other GI issues, followed closely by “I had trouble finding a formula that worked for my child.” A small but significant amount (14%) “(were) confused about formula or supplementing and felt lost on where to go for help.”
Real-world implications: More than half of those surveyed endured some sort of struggle with the technical aspects of formula feeding, suggesting that using formula is not as simple as “add powder and water” for many parents. I hear this excuse a lot from those who deny the importance of formula feeding education and support – that it doesn’t have a learning curve, that doctors don’t need to know much about it because every formula is the same, etc., etc. And that is certainly true for some people, but not for all. Not for over half of us.
Question 9: Did you experience any emotional challenges due to your choice to formula feed?
Only 18% of respondents said no, that they hadn’t experienced emotional challenges. The rest (who were allowed to choose more than one answer) mostly struggled with their choice or need to use formula (58%), and worried what others would think (55%). 35% felt “left out by other moms” and a quarter of respondents (26%) felt that the emotions around infant feeding contributed to postpartum depression and/or anxiety.
The open-ended responses included:
“I would have felt very comfortable in my decision to formula feed from the start if I had not been pushed into breastfeeding by the hospital, and also my mother and stepmother made me feel incredibly guilty. I had asked for info on bottle feeding while in the hospital and was snubbed. These issues contributed to my emotional challenges. It took almost 4 months for me to realize everything was okay.”
“I felt guilty for not feeling more guilty. Also felt like I didn’t try hard enough and that subconsciously maybe I was using PPD risk as an excuse. Oh, and I ended up with PPD anyway.”
“I was worried that all the negative health outcomes would come true- it’s pretty dirty to scare a mom into thinking that one choice could make her child overweight, less intelligent, and generally unhealthy. Happily, none of these things have come true in 3 years!”
“Despite knowing better, I felt guilty that I wasn’t giving my baby “the best.” That I hadn’t “tried hard enough” for her. The pediatrician at the hospital compared bottle feeding to “taking your baby to the drive through.” Thankfully her actual pediatricians were wonderful and told me it absolutely makes no difference either way.”
“I did feel some guilt about not breastfeeding, though I got over it rather quickly. What resonates more with me, though, is the fact that I didn’t want to breastfeed in the first place, but felt pressured friends, my community, the hospital, etc. to do it. And while it’s true that my kid had serious reflux, allergies, etc., and I had production problems, I also just HATED breastfeeding. And even sites like FFF sometimes make it sound like it’s only ok to FF if you tried to breastfeed and couldn’t. I’d love for women to have permission to just chose not to breastfeed in the first place.”
“I knew that there was no way that I could carry on attempting to BF and pump while still taking care of myself and my child (literally I would feed, attempt to pump, and he would be ready to eat again). But I could not relay that kind of feeling of desperation and failure to other moms who had no problems BF. I thought I was doing something wrong.”
“…I was confident in my decision about FF from birth, well educated and versed BUT still got side-eyed and looks from some people. No matter how confident you are when there are people who truly believe formula is poison and if you don’t BF you don’t deserve to have children (even when you fought with infertility to get said child) it’s disheartening. The lack of correct info on FF and the slew of misinformation on the benefits BF make it difficult to even the playing field.”
Real-world implications: Mothers are hurting. When over 80% of formula feeding parents are talking about the emotional ramifications of their feeding method, we need to sit up and listen. We have a large body of breastfeeding research now, but an abysmally small body of research on the effect of postpartum depression and adjustment difficulties on both mother and baby (not to mention other children, partners, employment, future relationships, etc.). If the way we approach infant feeding is contributing to emotional duress in a generation of parents, it seems worthwhile to reassess the risk/benefit of promoting breastfeeding in the way we currently do.
If we insist on continuing down the same path, then we need to also make sure that the negative experiences of formula feeding parents are tempered by appropriate measures. This means ensuring that they are treated with respect and with regard to personal autonomy; setting up social support systems like peer groups or pre/post-natal classes which address other methods of infant feeding; and perhaps providing sensitivity training for those dealing with newly postpartum or expectant parents so that they learn to impart the benefits of breastfeeding in a manner devoid of shame, guilt, or fear-mongering. It is possible, and it is well worth it.
Question 10: What country do you live in?
Most respondents were from English-speaking countries: the United States, Canada, the UK, Australia, and New Zealand.
Real-world implications: Not sure we can take much away from this, except that the reach of FFF (which is how respondents were recruited) is mostly in the English-speaking world. But while we’re on the subject… let’s address the need for culturally-specific infant feeding recommendations and policies. Even within the countries we’re discussing here – which on the surface have many similarities – there are demographic, socioeconomic, religions, cultural, and political differences. People cite the World Health Organization as a good source for formula feeding best practices, but it’s rather simplistic to try and make this issue universal. Mixing formula in a place with unsafe water and hygiene issues is quite different than doing so in a Lysol-happy kitchen using filtered, purified, boiled water and a dishwasher with a “sterilize” cycle. And that’s not even mentioning the impracticality of assuming that genetic, lifestyle, and dietary factors do not affect biological processes; to say IGT only affects 1% of the Swedish population, for example, means nothing to a demographic of Eastern European Jewish women in Manhattan. There are higher rates of breast cancer and Crohn’s disease in some ethnicities; higher rates of genetic diseases in others. Why should breast tissue be immune to these same factors?
I know I’m going off into tangents here, but the point is: it is time to think of infant feeding with more nuance, even in seemingly homogeneous populations. At the same time, we need to recognize that feelings of guilt, shame and fear are common in Western, relatively privileged demographics, regardless of breastfeeding rates and months of paid maternity leave. This is complicated stuff, and requires far more complex analysis than we’ve been given it. It’s time to step it up.
Question 11: What would have helped your experience with formula be more positive?
The highest amount of responses went to the following (again, respondents could choose multiple answers): more support and guidance from medical professionals (50%), more support and guidance from peers (45%), prenatal preparation for formula feeding (50%) and a peer support group for bottle feeding or combo-feeding parents (44%).
Real-world implications: All of this would be so simple to accomplish. If medical professionals were not scared to discuss formula, lest it be considered giving women “permission” to not breastfeed; if formula could be discussed in prenatal classes in an honest, clear, factual way; if we could stop making it “breast vs. bottle” and just make it two different, sometimes compatible, ways to feed a baby…. just imagine what could happen.
When La Leche League began, it was due to the inadequate support for breastfeeding mothers from society and physicians. While there are still battles to be fought, we are seeing more and more support for breastfeeding (as long as its done within the parameters of what is deemed “socially acceptable” – ie, for no more/no less than a year or two – which is most definitely a problem we need to address), if not from society as a whole, at least from the medical establishment, the government (at least in lip-service and funding for Baby Friendly and corporate lactation programs) and the parenting community. Now may be the time for a formula-feeding equivalent of LLL to do the same noble work – ensuring that moms (and dads – formula feeding is not gender-specific, and dads need to be included more in this conversation, especially those that are primary caregivers) are getting the support they need, when the powers that be cannot provide it themselves.
I will be following up with another survey soon, which will examine if there truly is a need for more “education” about formula feeding, or if it really is simple enough to merit the lack of focus given to it in prenatal and postnatal settings. But until then, I want to leave you with a few more of the comments left in the open-ended sections of this survey. My hope is that this will inspire those with the money and resources to conduct actual, peer-reviewed research on these topics to do so. At the very least, I hope it gets us thinking. Because we need to be thinking, and not just shouting at each other, endlessly, about who knows best.
“I just wish that they would give better instruction at the hospital to moms who choose to formula feed about mixing, feedings and choosing the right formula for your child. They send lactation consultants for breastfeeding moms. Why can’t they teach formula feeding moms a few pointers about formula feeding? We are all feeding babies. Why give one method so much attention and neglect another entirely? All that matters is babies get fed. Is that not the most important objective?”
“If there was more support (from) medical practitioners perhaps breastfeeding mums would be less critical.”
“I took a breastfeeding class, but looking back I wish it would have been a general baby feeding class. To learn about pros and cons of breastfeeding, formula feeding, using bottles, and starting solids. Because although not everyone will breastfeed, everyone will at least need to learn about several of these options.”
“I had no idea what I was doing and didn’t even know where I should look to find the information. It’s hard to find good formula info online and I didn’t know what to trust, especially when I was emotionally and physically exhausted and felt judged by others as well as by myself.”
“Can you fix the world and let everyone know that formula feeding isn’t bad? As long as you feed with love. This is such a touchy topic and I just wish everyone would let it go bc they only make it worse for moms. I also hate the attitude that formula feeding is okay IF you tried to breastfeed or IF you have low supply. I really want the attitude to be that there is nothing wrong with a mom who chooses to formula feed from the get go. Essentially if you could fix the whole attitude about how we feed our babies that would be great.”