Experiences of Formula Feeding: Results of a survey of 1,120 formula-feeding parents

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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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?

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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.”

 

FFF Recap 2013: What we learned about infant feeding (or didn’t) this year

It was a busy year in the world of infant feeding! Let’s review:

1. We learned that The Baby Friendly Initiative taking over more hospitals was “good news for mothers”. But some mothers don’t see forced rooming in as good news.

2. We learned that breastfeeding made kids smarter. We learned that breastfeeding didn’t make kids smarter. 

3. We learned that formula feeding causes more than 220,000 deaths per year, worldwide. Most of these are in developing nations, but the media and breastfeeding organizations don’t care to differentiate. Also, we learned that if you’re in a developed country, the benefits of breastfeeding are negligible (notice that these facts both come from the World Health Organization).

4. We learned that unscreened donor milk, purchased over the internet, was often contaminated by a variety of harmful pathogens. We were encouraged instead to engage in local, face-to-face breastmilk sharing, based on the belief that if you meet someone and talk to them and they are willing to give you their breastmilk, there’s little risk of them carrying diseases or engaging accidentally in improper transport or storage. We also learned that this study had too many methodological flaws. Which taught us that people are really great at being hyper-diligent about critiquing the quality of research when it fits their personal agenda and beliefs, but will turn a blind eye to similar critiques of studies that contradict them.

5. We learned that questioning a policy which appeared to put children in immediate danger meant that we were privileged, ignorant Westerners who had no business caring about people in other countries. Except if we were trying to donate our breastmilk to a nation struck by disaster, with spotty electricity, transportation, and access to refrigeration, in which case our privilege, ignorance  and Western-ness made us saints.

6. We learned that women are having trouble meeting their breastfeeding goals, not because of formula marketing, ignorance of the benefits, or because they didn’t give birth in BFHI hospitals, but because of issues like severe breast pain, trouble latching, or insufficient supply. We then learned that these problems were caused by the mothers’ lack of experience and knowledge, and not because there was anything physically wrong with them, despite the fact that the study did not perform physical examinations of the mothers and babies, nor did they obtain medical records.

7. We learned that “informed consent” meant being subjected to one-sided, biased information that mutated evidence into scare tactics, and that formula feeding information (which one assumes is an important part of the “informed” aspect of informed consent) was not a maternal or child health issue, but belonged buried in a website about food safety regulations, according to the Canadian government.

5. We learned that virtually all medications are safe for nursing mothers. Except for various antidepressants, pain killers typically prescribed for postpartum women, herbs, and galactogogues. But who’s counting.

4. We leaned, thanks to Beverly Turner, that misogyny is defined as women speaking up about how postpartum depression, sexual abuse, and personal autonomy affects their relationship with lactation. We also learned that Beverly Turner needs to read the dictionary.

5. We learned that, when it comes to infant outcomes, dads are chopped liver. Actually, all parenting methods are chopped liver, because the only thing that matters is mom’s education level, socioeconomic status, and breastfeeding history.

6. We learned that’s it’s fine for neonates to starve and get seriously dehydrated from insufficient milk, because they usually only have to stay in the hospital a few days to recover. Who cares about a few days in the hospital, besides new moms who feel like failures and those who do not have stellar insurance and have to take out a second mortgage on their homes to pay the exorbitant NICU bills?

7. We learned that breastfeeding probably doesn’t protect against obesity. A few months later, we learned that not only does formula feeding cause obesity, what a mom eats while pregnant is also to blame.

8.  We learned that despite all of this back-and-forth, advocacy-disguised-as-research, confusing crap, most mothers are completely supportive of each other’s feeding journeys. We learned that both breastfeeding and formula feeding moms get guilt-tripped and shamed, albeit from different sources. And best of all, we learned that when women band together and take a stand against intolerance, judgment, and hypocrisy, they can be heard.

It was a typical year in the infant feeding world, filled with contradiction and zealotry and unprofessionalism on all sides, and I have a feeling 2014 won’t be much different. But unlike past years, I have hope. #ISupportYou gave me proof that there is a peaceful army of women who are fed up with the status quo; who are ready for a new wave of support and advocacy. So in that spirit, my resolutions for 2014 are to continue to develop programs that will hopefully help women feed their babies in the healthiest way possible, in whatever way is best for them; to keep tabs on research that may cause unnecessary alarm for vulnerable new parents; and to ensure that womens’ bodily autonomy is respected while simultaneously protecting a woman’s right to breastfeed wherever, whenever, and however long she and her child wants. And to lose 10 pounds, but I guess that’s not really relevant to the discussion.

 

Announcing the “I Support You” Movement

Last week, I got together with a group of friends for a rare “mom’s night out”. We sat for hours, sipping white sangria and inhaling carcinogens from the nearby fire pit, laughing in that way only overtired, overstressed moms can when they finally get a chance to let loose.

I’d met these women at Mommy & Me when our firstborns – all boys, born within days of each other- were about 8 weeks old. So it was no surprise that as the night wore on and the wine glasses were emptied, our conversation turned to those hazy postpartum months, when we were younger, more confused versions of ourselves. I began inwardly musing how much we’d all evolved since then; how through two pregnancies each, our strength and power as women had stretched to new limits along with our bellies.

And then it happened.

“Do you guys remember breastfeeding support group? What a godsend that was!” one of my friends gushed.

“I remember sitting next to you and crying,” said another. “Eh, I think we were ALL crying,” another responded, and the whole group started laughing in self recognition and commiseration.

I felt my shoulders tense up, an ancient and forgotten ache shooting through them, down into my belly, where old pain dies hard. The ache grew deeper when one of my friends told me that my children probably didn’t sleep as long as hers did because she breastfed them, because “nursing gives them sleepy hormones”. And when another, trying so hard to be kind and include me in the conversation, reminisced about seeing my son in his infant carrier making little sucking movements with his lips as he slept, “as if he was still sucking on his bottle”.

And all I heard was “other”; all I heard was “different”.

The next day, I was interviewed for a documentary about breastfeeding, and asked about my journey from passionate breastfeeding wannabe to Fearless Formula Feeder. I’ve done interviews like this a hundred times now; told my story a hundred more. But this time, when I came to the part where I went to Mommy & Me for the first time – the first time I’d really been out in public, let alone surrounded by other moms and babies, as prior to that I’d been stuck at home attached to my pump and held down by the weight of postpartum depression and a baby who couldn’t stop crying, no matter what we did to soothe him – I felt the ancient pain rise up like bile in my throat. As I recalled sitting there, in a circle of nursing moms, feeling like all eyes were fixated on my bottle, judging me, I choked back ugly, rusty sobs. Rancid tears punctuated my typically canned tales of feeling separate, isolated, and constantly on the defensive.

I don’t think I’d realized how much the previous evening’s conversation had affected me. My children are 2.5 and 4.5; while some of my friends have younger babies or are still nursing their second-born toddlers, breast vs bottle is not something that our group is emotionally invested in. Breastfeeding, in and of itself, doesn’t really come up anymore. But breastfeeding support group does. The days we  they spent at the park discussing breastfeeding difficulties do. Those days carry a rosy glow for my friends, but my memories are tinged with gray. Those days I sat silent, clutching my son’s formula filled bottles, gritting my teeth through the inevitable comments about how terrified they were of having to supplement, smiling a frozen smile when a new mom would join our fold and ask the inevitable question “are you pumping?” which would be met with someone else in the group recounting my story of going above and beyond, as if I needed excusing.

Something I’ve heard a lot from those who don’t quite understand my passion for this issue is that “once your kids are out of the infant stage, you won’t care so much about breast or bottle.” And that’s true, to a large degree – the scary statistics and shaming memes don’t carry the same power; I’m able to dismiss them, laugh at them, debunk them without it affecting me personally. What surprised me about the other night and my subsequent breakdown over faded memories, is that while the logistics cease to matter, the old pain and doubt are always there.

There’s a lot of research out there about imprinting, and how first experiences affect infants. But isn’t new motherhood a sort of infancy, itself? Here you are, reborn into mother, your skin and organs and thoughts raw and foreign. Everything is new. Everything is a first, postpartum- your first shower, the first time you have sex, the first time you take the baby for a walk, the first time you feel confident in your new role. Is it surprising, then, that your first social interactions as a mother don’t imprint on you in the same way a new food imprints on an infant’s taste buds?

What would have my postpartum experience been like if I could’ve sat next to my new friends without being afraid of what they’d been made to believe about formula feeding? If I could’ve attended a support group in those first weeks, too, and not had to wait 8 weeks before my community allowed me the gift of peer interaction? And what would my friends’ experiences have been like if they hadn’t been made to feel like failures for the supplementing they had to do, or made to believe that their ability to breastfeed was what made a mother worth her title? What if we could have all been supported in our individual experiences and goals, without fear of some Orwellian gaze, labeling us with a “pass” or “fail”?

And most of all…. what would have happened if I’d had the courage to speak up; to give voice to my demons, to help my friends understand how their innocent words could hurt more than my Pitocin-induced labor pains? What if we could have spoken openly, and found our differences to be our power, the power that could bring light to our fundamental sameness?

World Breastfeeding Week begins in a few days, and the theme this year is “Breastfeeding Support – Close to Mothers”. This is a fantastic theme, because breastfeeding moms need tremendous support, especially in those early days. But I think we should be taking this a step further. ALL new moms need support. Hell, all moms – those with toddlers, those birthing their fourth babies, those with teenagers – need support.  I think brand new moms are the most vulnerable, though; these are the women who are not only dealing with all the craziness that babies bring, but also their own rebirth.

I want to support breastfeeding mothers. I wanted to support my friends, in those early days; I wanted to help them through their struggles, but I felt trapped by my own insecurity. Their efforts seemed like an indictment of my choice. Their well-meaning questions about whether I’d tried talking to a lactation consultant (try seven) felt like judgment.

The problem is not us, us mothers just trying to do our best for our babies, us mothers desperately seeking a tribe, a source of support, a group to someday drink sangria with and laugh about how tough those first few weeks were. The problem is with how breastfeeding has become the antithesis of formula feeding; the problem is with how the two are set up as black and white, as polar opposites, as competing interests – rather than as two entirely independent, valid ways to feed children. Those promoting breastfeeding because they honestly believe formula is risky can continue to do so, but I think there is space for a new type of breastfeeding advocacy and support: one that celebrates and honors mothers’ autonomy, and focuses energy on providing REAL support to those who need it, regardless of feeding method. If infant feeding wasn’t set up as a succeed/fail dichotomy from the beginning, imagine how moms might be able to support each other without feeling alienated or judged for different choices?

My belief that this type of advocacy would be far more powerful in helping mothers meet their breastfeeding goals is what has inspired me to join forces with Kim Simon of Mama By The Bay and Jamie Lynne Grumet of I Am Not the Babysitter, to encourage moms to stand up and say “I Support You”.

Created by Cary Lynn Davis

Created by Cary Davis

The I Support You movement is a respectful, empathetic, compassionate exchange between parents.  We all feed our children differently, but we are all feeding with love, and in ways that work for our individual circumstances and family dynamics.  I Support You is the first step in helping formula-feeding, breast-feeding, and combo-feeding parents to come together and lift each other up with kindness and understanding. We have chosen to announce this movement during World Breastfeeding Week, to honor the commitment of those who fight for better support for breastfeeding moms; we are inspired by this, but believe that by changing the focus to supporting all parents, we can truly provoke positive change without putting the needs of some mothers above the needs of others. The “I Support You” movement aims:

 

1) To bridge the gap between formula-feeding and breastfeeding parents by fostering friendships and interactions.

 

2) To dispel common myths and misperceptions about formula feeding and breastfeeding, by asking parents to share their stories, and really listening to the truth of their experiences.

 

3) To provide information and support to parents as they make decisions about how to feed their children.

 

4) To connect parents with local resources, mentors, and friends who are feeding their children in similar ways.

 

(written by Kim Simon with a tiny bit of help from me)

 

If you want to join the movement and celebrate real support with us:

 

Send us your photos. I’m creating a slideshow of photos to show how beautiful support can look. If you are willing to let me use your image, take a photo of you, your baby, your family, you and a friend – doesn’t matter – with a message of support (i.e., “I exclusively breastfed, but I know every mother does what is right for her – and I SUPPORT YOU” or “I may formula feed, but I’d fight like hell for a woman’s right to NIP. I SUPPORT YOU”) and send it to formulafeeders@gmail.com by Friday, August 2nd.

 

Interview Your Opposite. Are you a blogger?  Are you a formula-feeder who is best friends with an extended breastfeeder?  An adoptive parent who knows of a mom using an SNS nurser with a baby in the NICU?  We want you to interview someone who is feeding in a different way than you are, and then publish it on your blog.  If you’re interested in participating but don’t know where to start, feel free to email me at formulafeeders@gmail.com for a list of interview questions.  On  Sunday, August 4th, we will ask you to share your story with us, by adding your link to the I Support You blog hop. If you don’t know anyone who feeds in a different way,  send me an email and I’ll try and connect you to someone.

 

Join us for a Twitter Party on August 7th, at 5pm PST/8pm EST.  We’ll be asking you to share your truths about your feeding choices, and connecting you to other parents who might be feeding their children the same way.  You can find us with the hashtag #ISupportYou.

 

Create your own meme or message of support. If you’re tech savvy, feel free to create a meme or shareable video that honors the “I Support You” message, and share it on the FFF Facebook page.

 

Check out Kim’s incredible, spine-tingling post on the “I Support You” movement, here.

 

The best way to counteract hate is by drowning it in a sea of change. The tide is rising, and we can float above the negativity and fear; push down the us-versus-them bullshit and let it sink to the bottom, where it belongs; lure it to its death with a siren song of I support you, sung far and wide.

 

Start swimming, fearless ones. I support you.

Support versus advocacy: how finding balance is like keeping a white carpet clean

I lost a few very dear followers over on the Facebook page recently (and I assume on the blog as well), and I’ve been obsessing over their departure. As too often happens on the FFF community page, we have been visited by a few breastfeeding advocates who have, at times, pushed their agenda to an uncomfortable (and sometimes quite emotionally triggering) point. Tempers flared, statistics and studies were tossed around like grenades, and my failure to wield the “ban stick” resulted in a loss of security for some members. They no longer felt safe around the FFF community; no longer felt like it was a positive and healthy place to heal their postpartum wounds and work through their feelings about infant feeding.

Yeah. Shitty.

What really burns me up about this is that in trying to stay open and neutral, I have singlehandedly sullied a place which I’d built to be the safe haven I personally craved. Even I have felt a pit in my stomach when I’ve gone over there lately, wincing in anticipation for the latest infiltration of misplaced “education” or not-so-thinly-veiled hatred (like a comment the other day that referred to me as the “Bitter Formula Feeder.”) When you don’t want to visit your own page, you know there’s a problem.

Some colleagues have suggested that I haven’t protected my community from the types of voices which have already caused so much hurt in their hearts. I fear this is true – people come to a page called “The Fearless Formula Feeder”, not knowing squat about my blog, and assuming that it will be a safe place to discuss bottle feeding and negative feelings about breastfeeding. Instead, they find acrimonious debates about the dangers of formula and critiques of the way that they are choosing to nourish their children. It ignites anger (quite justifiably) and people lash out, sometimes in the wrong direction. They expect me to come to their defense, and it takes every ounce of my being not to lunge like a bloodthirsty mama lioness, but I usually don’t.

What kind of fearless leader does this make me? Not a very good one, I fear. I completely sympathize with the people who feel betrayed by my allowance of dissenting voices, and encouragement of highly emotional debate. There was a time, not so long ago, that I would have felt the same way.

The problem is, I’m against hypocrisy more than I’m against anything (well, maybe not anything. I mean I’m probably more against human trafficking or the unethical treatment of animals or John Wayne Gacy… but you get the point). It would be agonizingly hypocritical of me to only allow those who agree with me to post on this blog, or on my Facebook page. Now, there’s a fine line between being outright obnoxious and posting things which challenge someone else’s beliefs. In the case of the former, I have no problem wielding my ban stick with a theatrical flourish. But with the latter? Well, I’ve had that happen to me on other anti-formula blogs, just because I politely dissented, and it sucks. I don’t want to be part of the very problem I rage against.

Unfortunately, it’s hard to know where to draw the line. Having someone come and throw the same studies we’ve discussed and (I believe quite fairly) critiqued on this blog in our faces every day can feel rather antagonizing and confrontational. Sometimes, I will attempt to express this – telling the person in question that we are well aware that WHO ranks formula feeding fourth in its hierarchy of feeding, and that breastfeeding contains live blood cells, and that studies have shown that formula feeding leads to SIDS, cancer, and the plague, and the slaughter of innocent lambs at the alter of Enfamil, and so forth. And sometimes they keep pushing. And sometimes it makes me want to stick my head in the oven.

When this happens – when the attempt at “education” or “correcting misinformation” becomes aggressive and contrary to the purpose of my page (which is outlined here, if you’re wondering), people begin to get bitterly angry. I understand this, because I feel the same anger. I have to fight against it, sometimes ranting to Fearless Husband for hours on end to get the rage out. But I have the advantage of having done this for nearly four years, and I’ve heard so much hate, passive aggressive “education”, pity, and condescension that it begins to blur into a nice, easy-to-ignore din. For many of you, the wounds are just too fresh, and these people are pouring salt into a wound, and then pouring on some vinegar for good measure even after you’ve asked them to stop the salt. It sucks, I get that.

At the same time, though, I also notice myself allowing people on “our side” to engage in name calling and, at times, unfair attacks. That’s because, on the most fundamental level, I think we are in the right. It is our territory – a place that is supposed to be free from drama, free from the usual critical voices. If someone wants to come into our house and visit for awhile, I’d appreciate they didn’t stomp around with muddy boots.

The thing is, sometimes the boots aren’t exactly caked in mud – sometimes these guests just have a bit of sand on the bottoms. We’re already so sick of vaccuuming up after rude guests, though, that the tiniest bit of sand is enough to turn us apoplectic. And that is where I get uncomfortable, because I don’t want to stoop to the level of other communities, where the slightest disagreement is treated like a federal offense. If it’s just a little sand, maybe it’s better to just kick it aside, and see if offering the guest a drink of water might just make them sit tight for a minute and stop tracking sand all over the floor.

I get that this can veer into uncomfortable interactions for some people, because hey, when you’ve been treated like freaking Cinderella and forced to clean up someone else’s shit while simultaneously ridiculed and insulted, a tiny bit of sand can be a huge pain in the ass. But I’ve seen the same people who initially came in tracking mud on the floor turn around and ask if they could help mop it up. Sometimes you just need to give someone a chance. Sometimes you catch more flies with honey than with vinegar (a nice reminder for those perpetuating the salt-and-vinegar torture I alluded to above).

I see Fearless Formula Feeder – the site, the Facebook page, and the persona- as standing for infant feeding freedom first and foremost. But FFF also stands for honesty, open-mindedness, respect, and fairness. We have to give people a chance to engage with us if we’re going to make any progress in ending this ridiculous breast vs bottle war. I know, I know – many of us feel like it’s only a war because the “other side” has made it so, and I think there is a lot of truth to that. And I know it feels really sucky to have to be the bigger person and treat others how you want to be treated, especially when they aren’t giving you the same respect.

Don’t get me wrong – this doesn’t mean you can’t fight fire with fire. I love the articulate, targeted way some of you choose to fight back. You fight science with science, studies with studies, anecdotes with anecdotes. That’s the way to do it. Stooping to calling someone a “lactonazi” or making blanket statements about breastfeeding mothers is only perpetuating the belief that all formula feeders are anti-breastfeeding, when I know most of us are the farthest thing from it. I don’t want to feel like a sanctimonious jerk by reminding the community about that. I also don’t want to seem like I am not jumping to the defense of those I care so deeply about defending.

I think the point of this rant is as follows: FFF serves a few purposes – it exists to support mothers who are bottle feeding in a practical manner, both emotionally and with research-based and peer-oriented advice on feeding logistics. It also exists as an advocacy site, to protect the rights of formula feeding, tube feeding, and combo feeding parents. It supports  women in their individual breastfeeding journeys (i.e., helping with encouragement for moms wanting to try again, or moms who are currently struggling but want to continue to breastfeed). And it promotes a conversation between infant feeding activists, mothers, physicians, researchers, and interested parties to try and make some progress so that things aren’t so crappy for future generations of mothers.

Therefore, the Facebook page is sometimes not going to be a safe haven. There are going to be times when someone might say something that hurts you deeply, and I invite you to express that hurt, and strike out in the most powerful way you can – by speaking your truth, being proud of your choices, and knowing that the power of the community is behind you. And my promise to you is that while I will gladly allow the sandy shoed folks to hang around and contribute, I will not stand for people tracking mud all over my living room. Or if they do, they better plan to stick around and Hoover the crap out of the place.

 

Introducing the Family-Friendly Hospital Initiative

My first experience with a baby friendly hospital was far from pleasant….because no one had really showed me how to attach, just pushed and shoved my breast, my nipples became blistered and bloody…As day 3 approached it was clear my son was having a few issues.  He was becoming jaundiced, he still hadn’t passed any sort of wee.  This was when the contradictory advice began.  One told me he was a lazy sucker and that I had to watch for Nutritive sucking, where his whole jaw was moving, all the dummy sucking was not getting him any milk.  Another midwife told me that was nonsense and any sucking was getting him milk.  One told me my latch was good, another told me it was rubbish.  It seemed with every shift change I got another piece of different advice.  I was more confused than I had ever been in my life and I had absolutely no idea what I was doing.  They had me constantly hooked up to the breast pump, hoping to encourage my milk in but I never got even a drop out…he had lost nearly 30% of his body weight in 3 days, they aim for 10% at the most.  I felt angry,  I had told them my baby was starving.  Any time I had asked for formula I was told it would affect my milk supply and refused…I had to sign a form allowing him to have the bottle.  He gulped it down and went straight to sleep.  The first time really since he had been born.  The next morning when with a new midwife when I asked for another formula top up I was given a spiel on how ridiculous it was to have given it too him in the first place and I would destroy any chance of ever having any milk.  When my husband asked which formula they recommended if we decided to go that way because he could see how thoroughly overwhelmed I was he was told they don’t recommend formula.  Those two bottles allowed his weight to go up enough however to allow us home after another night so we finally got out of there.  I left exhausted, nipples absolutely shredded, confused, overwhelmed and violated….Baby friendly maybe, mother friendly most definitely not. - Courtney

“My local hospital is “baby-friendly”…  My own opinion of this implementation is that it was distinctly “mother unfriendly” - to the point I’m still traumatized by what went on now and regularly cry myself to sleep over it all. My daughter came prematurely, was sent to NICU, while I was sent to the post-natal ward… I had a leaflet on breastfeeding slung at me, and when I pointed out it was a tad insensitive- I had a premature baby in an incubator not even on the same floor in the hospital as me, and I couldn’t do anything since she wasn’t even WITH me (none of the staff had broached expressing or pumping at this point) – I got snarled at that “breastfeeding is really important you know” and the nurse flounced off…After about a week and a half, when I was truly at the point of crumbling, when we’d made no progress at all with breastfeeding and latching, one wonderful nurse put her neck on the line and broached the taboo (bottles, formula and teats were very much the elephant in the room everyone was too scared to mention) and told me that basically I would be looking at extending our time in hospital by another 2-3 weeks in order to be able to go home breastfeeding… I asked to try her with some of this expressed milk in a bottle to see what she would take… From there she really turned the corner. However because of being “baby friendly” – the bottles, teats and formula were hidden away behind the nurses’ station (very similar to the NYC proposals) – you had to do the walk of shame, akin to being on the Weakest Link, to go and collect them… it was literally a matter of a few days from that first bottle feed to her being able to take her full feed requirements and maintain/gain weight and have her feeding tube removed – the hospital would have let me plod on in ignorance that this was possible to sacrifice my mental health on the altar of their baby friendly status quite happily. The prolonged stressful nature of our hospital stay has left me with an anxiety disorder requiring medication, sleep problems and I cry myself to sleep on many many nights over the trauma we went through – this is after counselling as well. I switched to formula feeding as my supply dwindled and my breast pump motor died in the end.” -F.T.

A colleague said something to me last week that really knocked me on my ass. She asked if I had lost my passion for this blog, and for the cause in general; she told me that FFF “wasn’t what it was” a year ago. I’ve reflected on this for the past 5 days, and I started wondering if maybe I was the Internet equivalent of an aging beauty queen, hanging out at the local cougar bar and wearing pants that were more appropriate for my 14-year-old daughter. It was a scary thought. (And a little too close to home, as I still shop in the Juniors department, on occasion.)

On further reflection though, I don’t think I’m old, or tired, or lacking passion – I’m just a little jaded. I’m jaded because I realize that blogs can only go so far; that the time has come to take FFF to the next level and begin forming concrete advocacy efforts and fighting for real, practical change that can lead to flesh-and-bones support, rather than just the virtual kind.

This advocacy will begin with an endeavor I am calling the Family Friendly Hospital Initiative (FFHI). I originally planned to call it the “Mother-Friendly” initiative since the mothers are the ones physically engaged in breastfeeding, but ultimately chose the name “Family Friendly” to reflect the fact that families are made up of not only babies and mothers, but also biological fathers, adoptive parents, gay and lesbian spouses, and siblings with their own specific needs. We need to approach all types of famiIies in a holistic manner, recognizing that the health, happiness and economic stability of the entire family is vitally important to emotional and physical health of a growing infant and to our society as a whole.

I plan to approach hospitals, local media, and government officials to encourage adoption of the FFHI, a program that can work in conjunction with the BFHI Ten Steps, taking the best parts of that program and clarifying the aspects that could potentially infringe on a woman’s right to choose how to use her body. I am going to fight, tooth and nail, for hospitals to start offering bottle-feeding classes, or if this isn’t a possibility, perhaps giving access to a hotline to connect new moms with trained peer advisers who can walk them through safe formula preparation, outline the best pumping and milk storage practices, offer suggestions to common formula concerns and complaints, and hopefully provide peer support groups which can meet, much like breastfeeding support groups, but for formula-feeding, pumping, tube feeding and combo-feeding mothers.

There is no reason that supporting and promoting breastfeeding has to mean punishing the women who either choose to formula feed, or end up doing so for any number of valid reasons. The Family Friendly Hospital Initiative will promote breastfeeding as the healthiest choice, but will frame it as a truly informed choice, giving concrete, real-world statistics in contexts that any parent can understand, not just the ones with a degree in epidemiology. It will adhere to practices shown to improve breastfeeding rates, but make the ultimate goal a healthy, fed baby and a confident, emotionally healthy mother and/or father. The FFHI will reach out to postpartum mental health professionals and organizations and attempt to make maternal postpartum health a significant priority. It will encourage researchers to engage in studies which will learn from women who are not breastfeeding, rather than dismissing them; studies which will make bottle-feeding (whether it be formula, donated milk, or expressed maternal milk) safer; studies which will help us determine how our societal evolution has affected breastfeeding, and how to merge a woman’s innate desire to feed her child naturally with the reality of an incredibly unnatural world.

Take the good….

“…Every nurse who came to check on us was extremely respectful. They all asked before touching me and gave great advice about how to get him latched and how to take care of myself while breast feeding. Once we were discharged, we received follow up care from community health nurses. They check on everyone by phone, but came to visit us in home after hearing about the number of times my son had been up to feed. They weighed him and provided a lot of encouragement. When the jaundice was getting worse, not better, it was a community health nurse who was also a lactation consultant who said, ‘How do you feel about formula supplementation?’” - Lisa

“Baby 3 was born in a baby friendly hospital and was my best experience.  The LC came in just to see how I was going to feed and offered support with breastfeeding or formula feeding.  She just wanted to see mommy and baby happy.  She even checked on me knowing full well my baby was receiving a bottle just to make sure she wasn’t having any issues with the formula.  I breastfeed baby girl enough for the colostrum like son 2- but I didn’t feel judged at the hospital at all- in fact I felt fully supported.”   -Betsy 

 

When I asked my Facebook followers to share their experiences of “baby friendly” hospitals, I was shocked – and not for the reasons you might think. I was expecting tales of shaming, mistreatment, and inferior assistance with the actual mechanics of breastfeeding. But instead, the majority of the stories posted on my Facebook wall were positive. “I went in planning to use formula. I was so nervous,” says Amy. “Every single person was supportive, did not say one single word about it, and several actually expressed relief for me! …They didn’t have much advice on stopping my milk but they tried. My pediatrician seemed thrilled too. I went in ready to defend and they were all SO fantastic.” Natalie reports that the “hospital staff were all very kind. Every time they asked if I was going to try breastfeeding, I would start with my big long explanation, and they’d stop me right away and say ‘it’s your choice, you don’t need to explain’”. A few readers had given birth in both baby-friendly establishments and hospitals that hadn’t adopted the initiative, and they gave much higher marks to the baby-friendly ones. Allowing babies to room in, experience skin-to-skin immediately after birth, and having more lactation consultants or breastfeeding-educated nurses on staff are changes most new mothers would applaud. Obviously, there are elements to the baby-friendly program that should be commended and implemented worldwide.

…But Leave the Bad

I delivered at a baby-friendly hospital. I had intended on giving breastfeeding a try but was not sure I wanted to do it long term…When I delivered, a nurse helped me initiate breastfeeding…He was not latching well, which I assumed the LC would have told me. I now found out that it is against their policy to use prosthetics (shield), which would most likely have saved our nursing relationship and helped my sleepy baby latch… They checked his bili levels and they were sky high. I told the night nurse she could feed him formula and I was fine with that. She fed him 25ml through a syringe. The next morning I was told the machine used to check the levels was malfunctioning and he was actually fine. The LC berated me for allowing my baby formula. After our release he became too tired to latch and would scream. The pediatrician told me I should supplement. I gave him a bottle, and he refused to nurse. By the next day, he had gained 4oz and changed color. I stopped after that for my own sanity and recovery. My experience wasn’t horrible at the hospital, but when I was looked down upon for allowing him formula I felt as though it wasn’t so much about me making a decision I thought was best, but them not being able to check off that ‘exclusively BF’ checkbox.” -Sara

“Because of my problems with (my first child) I was leaning towards formula but still wanted to attempt the breast or at least get the colostrom benefits.  When the lactation consultant came in, she was rude.  So rude.  I explained my troubles with my first son- where she informed me that the problems I experienced were impossible, she isn’t there to convince me to breastfeed, and I am sabotaging my efforts with son 2.  By the time she left the room, I was crying. Literally crying.  I told the nurse to get my son a bottle of formula so I would never need to see that woman again.  Turns out son 2 tongue sat back in his mouth a little too far and needed a preemie bottle nipple.  LC might have caught that and offered me a shield or something if she hadn’t been there to just berate the hell out of me. - Betsy 

Despite the numerous positive experiences voiced in this small sample, adopting procedures which focus on an end goal (having most babies exclusively breastfed upon discharge from the hospital) can lead some care providers to fall prey to human tendencies of fear, selfishness, and bias. It is evident that so much depends on the individual care providers and administrators of each hospital; the Baby Friendly Hospital Initiative (BFHI) is based on the organization’s Ten Steps to Successful Breastfeeding, which are meant to “promote, protect, and support breastfeeding”. Yet, the program is often simultaneously promoted as a way to improve maternity care in the United States, to bring hospital birthing to a more personalized, less sterile level. And while these two goals might seem to work in tandem, there’s too much left to interpretation in the Ten Steps to ensure that they really do. In fact, in some cases, it seems that the emphasis on exclusive breastfeeding for the good of the babies is subjugating the needs, autonomy, responsibility, rights and desires of the mothers.

Still, I do believe that things must change in our hospital system so that women will be supported in their efforts to breastfeed. New mothers shouldn’t be sabotaged or bullied, no matter if the substance in question is formula or breastmilk. And the early days of breastfeeding are incredibly vital – both physically and emotionally. I simply want to make sure that women are supported in both the former and the latter respects.

Engage the professionals

“My son was born in a “baby-friendly” hospital. In theory, it’s all very good and helpful, but I feel the nurses need to be given a reminder about personal boundaries and coherent advice. I was pretty upset that they wouldn’t let my husband hold him after the birth and that they manhandled my breasts (without asking first) to try to painfully extract some colostrum (which I didn’t have at all) because my son apparently needed to have some *right now*. I was exhausted and just wanted to be left alone. I wanted my husband to take the baby so I could sleep. There was a lot of manhandling and nipple-pinching during the next feeding attempts, which was very painful and disturbing…Also, my son slept for most of his 48-hours hospital stay. I went to the nurses station to ask them if I should wake him to feed him and I was told “no”, but when I was discharged, a nurse scolded me for not attempting to nurse every 3 hours. I felt confused and misdirected. I was happy to leave!”  -Roxane

I believe that most people go into the medical field – a care profession – to help others. We cannot ask nurses and physicians – professionals who carry the credo do no harm close to their hearts – to subjugate the needs of one patient for that of another. We should be asking these professionals to work with us to improve infant feeding practices, rather than demanding they behave in certain ways (ways that may be in direct conflict to their instincts as caregivers) in order to meet government goals. Therefore, I hope that medical professionals – especially maternity care specialists – will join me in urging the adoption of this initiative. Perhaps it will also be more palatable to hospitals who have shied away from becoming baby-friendly; if the goal is to end practices which sabotage breastfeeding, it shouldn’t matter whether we do it via WHO/UNICEF-endorsed methods or our own modified American version.

As I’ve been researching the BFHI, another realization I’ve had is that despite all intentions, women are still being given atrocious advice in baby-friendly hospitals- advice that would make most experienced LC’s cringe. A friend recently gave birth at a Kaiser hospital here in California, one that prides itself on being Baby Friendly. She told me the most curious tale of how, when her newborn didn’t latch right away (and I’m talking like 3 minutes into the first skin-to-skin, right after the cord had been cut), a nurse dribbled formula all over my friend’s chest, apparently to encourage the baby to latch. Considering step 6 of the BFHI is “Give newborn infants no food or drink other than breastmilk, unless medically indicated” and my friend’s baby was born perfectly healthy, I have no flipping idea why this would have been done.

I suspect that when the focus is solely on having women leave the hospital breastfeeding exclusively, rather than on encouraging long-lasting, healthy, happy breastfeeding dyads, bizarre and contradictory actions will continue to occur. By talking with healthcare professionals rather than treating them as the enemy, or assuming they are all pawns for the formula industry, we can hopefully come up with better protocols that lead to better outcomes overall.

Encourage individualized patient care

“My baby latched perfectly and all was great. Except that I hated it. No matter what the hospital does, I believe women will quit breastfeeding for all kinds of reasons. I hate calling it “succeeding” at breastfeeding because I think success is determined by a happy healthy baby and mom, which isn’t always breastfeeding.” - Erin

“I have 2 sons, now 2 and 4.  I also have PCOS and hypoplastic breasts.  I tried to breastfeed my first, didn’t work.  Didn’t even try with the second (with the blessing of the same LC who was at the same hospital and remembered me!  Took one look at me and said, “nope, don’t bother.”).  By the time I had my 2nd child, the hospital had become “breast friendly”, in their words.  So they were not giving away the formula bags and samples any longer.  Nurses told me that they actually had to THROW THEM AWAY.  Since I had been expecting these items, I was shocked to hear this.  When the director of nursing stopped by to take a little survey on my stay, I really let her have it.  “But we’re BREAST FRIENDLY” she kept repeating.  My response?  ’Well guess what honey, my breasts aren’t very friendly, and they don’t make milk’”.-Rebecca

I actually believe that most of the 10 Steps outlined on the BFHI website are perfect for encouraging breastfeeding, and seem to reflect the research that has been published on this issue. But I think that there is a fundamental flaw in the program: it does not give sufficient attention to the needs of bottle-feeding parents. Mothers have different birth experiences, different socioeconomic backgrounds, different ethnicities, different emotional makeups, different physical impediments. Mothers are different. Treating all American mothers as one homogeneous, uniformly-lactating group is a recipe for disaster. There’s a movement afoot to change the face of maternity care in this country – homebirths, or hospital births assisted by doulas or performed by midwives are becoming more popular. We seem to be having two parallel conversations – one that says “treat me like an individual, not as a medical case to be managed” when it comes to birth, and one that begs for overly-monitored, medicalized, one-size-fits-all treatment when it comes to breastfeeding.

There is no reason we can’t follow most of the BFHI steps, and still provide resources, emotionally neutral education, and equal support for those who opt to combo feed or formula feed.

Education, Not Indoctrination

“No discussion of challenges in our BFing class, just all the joys and benefits. Frankly, I think it’s much better to discuss potential problems even if they affect only 10% or so of mother-baby pairs. Knowledge is power, and you aren’t blindsided by pressure or bullying or confusion either way in the days immediately after birth if you know what to expect. I seriously don’t understand why anyone would think it wasn’t important to discuss potential problems. It would be so much better for getting people to know when to get help.” -Sumita

“In fairness breast feeding wasn’t really covered either – it was more here are the benefits this is why you should – and this is briefly how it’s done- we will show you when you have your baby. Formula wasn’t even mentioned at all. - Kate 

I took a breast feeding class at the baby friendly hospital I have birth in. They never talked about any problems that could come up. Only the benefits and good things about breast feeding. I spoke to a nurse while I was in the hospital and asked her how come I wasn’t told about flat nipples, latching issues and such and she said that they don’t discuss negative things in the breast feeding class so that women aren’t discouraged. In my case it would have been very helpful to know about issues like that because it would have avoided me getting depressed about not being able to breast feed my premature baby.” -Rosella

“We are set up for failure and every real life mom I know knows it. SO many women I talk to NOW commiserate with how hard it can be, but all the literature, all the websites give such an opposite impression. Like, why WOULDN’T you breastfeed if its beautiful, bonding and almost everyone can do it? If everything they said was true, everyone WOULD breastfeed. But its not true for everyone.Rachel 

The number of mistakes I made formula feeding my first born because of the lack of info frightens the hell out of me to this day. I called a nurse hotline once to ask some questions and got a lecture about how I should try to re-induce lactation.” - Mina 

Regardless of what happens in the 48 hours after delivery, the education parents are receiving about infant feeding is downright embarrassing. Classes drill the importance of breastfeeding into our heads without giving us much practical information on how to actually nurse; this is somewhat understandable as it’s the kind of thing you can’t really learn without doing. However, a brief acknowledgment of some of the more common complications would be an easy thing to add to prenatal curricula - latching issues, flat or inverted nipples, tongue ties, commonly used drugs that may be contraindicated, health conditions such as diabetes or PCOS which could potentially complicate breastfeeding – and doing so would prevent many women from feeling like failures when breastfeeding doesn’t come easily. Considering the emphasis on avoiding nipple confusion and establishing milk supply in the first few weeks which permeates the canon of breastfeeding advocacy literature, it seems logical that we should do whatever we can to ensure that women are not blindsided by these issues – forewarned, they could come up with a solid plan with a lactation professional which could prevent actions made in moments of confusion and panic.

Additionally, the lack of education about formula feeding is a travesty. I have written about this many times before, but I will reiterate: if only 36% of American mothers are breastfeeding exclusively at 3 months, that means a majority of babies are being fed formula. It is IMPERATIVE that they are properly supported in doing so. Ignoring the fact that formula is a reality in the lives of many parents doesn’t just punish the parents- it affects the babies. True, formula feeding isn’t brain surgery – but it could be argued that breastfeeding is an instinctual act for humans. Formula feeding? There’s nothing instinctual about it. There is a huge margin for error. I personally suspect that many of the subtle health disparities we see in the aggregate between formula fed and breastfed babies are due to avoidable and common mistakes in formula preparation and selection. Most parents have no idea what the difference is between a “sensitive”, “hypoallergenic”, or “lactose-free” formula. They don’t know that the angle of the bottle, the flow of the nipple, and the type of formula (powdered, liquid, concentrated) could affect their baby’s digestive system. They don’t know what water to use, how often they really have to sterilize bottles, or what formula to choose. They must rely on friends and the internet for advice about something that should be – unlike breastfeeding – a regimented and meticulous process (sadly, it seems our society has this flipped. Breastfeeding is treated like brain surgery, and formula feeding is seen as something we should inherently know how to do…). Medical professionals may be used to the “formula feeding model” for things like weight gain and feeding schedules, but even this is more true of the “old guard” (those who have been practicing for a long while, before breastfeeding’s resurgence) and these same folks might not be aware that there’s been research and new thought on the bottle-feeding front since they got out of med school in 1963.

I propose that breastfeeding education be altered to reflect some of the realities of breastfeeding – common challenges, medications, diet, and pumping – the same things discussed on KellyMom, Mothering.com, and The Bump. I also want to see hospitals offering bottle-feeding classes and resources once a mother has voiced a desire to either supplement or completely formula feed.

The “Parent-Friendly” Manifesto

I am not sure what form this “initiative” will take just yet, but I am hoping that FFFs across the country will join me in advocating for positive change. It is healthy and necessary to mourn the loss of breastfeeding, or rage against the current atmosphere of shaming and belittling formula feeding moms – but we can turn that anger and grief into positive change. I know we can. Let’s work on this, together, so that no new moms have to go through what we have gone through. Let’s make it so  FFF Fridays become obsolete, because there will be so few people who feel bullied, abused, or let down by their experiences. Let’s make my friend’s comment a reality – make it so that I have lost my passion, because there will be nothing left to get fired up about.

Who’s with me?

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