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?

Why you should take experts with a grain of salt (and a FFF team project!)

As I’ve mentioned in previous posts, I recently switched from freelancing to a more steady form of employment. I’m lucky enough to have found a job which allows me access to some of the foremost experts in the parenting world, as well as an incredible roster of parents with unique situations and viewpoints.

These past few weeks, I’ve been a fly on the wall as these folks have been interviewed about their areas of expertise and experience. It’s been truly enlightening, both as a parent and someone who finds it fascinating to pick apart the human psyche. Some key observations:

1. Just because someone is a “world-renowned expert” does not necessarily mean they understand the real-world implications of what they are advocating.

For obvious reasons, my favorite example of this is the Male Breastfeeding Expert. There’s nothing like having someone with testicles school you on why it isn’t that big a deal to breastfeeding exclusively for six months. Or the 75-year-old parenting expert who tries to compare the way the world was at the time she was raising her sons to how it is now. Oh- and the expert who was born and raised in wealth and privilege, scoffing at the idea that poor, urban parents can’t find ways to feed their children healthier meals and get them 2 hours of exercise.

Look. These days, it doesn’t take much to be proclaimed an “expert”. You write a few books, get a few prominent clients, get yourself on the Today Show, and viola! World-renowned expert. Degrees help, but even these can be misleading – a PhD in philosophy can call herself a doctor and become an expert on child health with nary a pre-med course under her Prada belt. (Think of Dr. Linda Folden-Palmer, the woman who claims that formula feeding has killed more American babies than anything else in the world. She wears that “Dr.” title like a badge, neglecting to mention she’s a Doctor of Chiropractic.)

Even for those select few who really do have the research, education, and experience behind them to qualify as experts, it doesn’t necessarily follow that these folks have a clue what life is like outside their ivory towers. Theory and practice are two different animals, altogether. This doesn’t mean they don’t know what they are talking about – to the contrary, they can probably speak eloquently and informatively on their given subject. But academia tends to be insular; psychologists aren’t necessarily talking with anthropologists; biologists aren’t always having brainstorming sessions with sociologists. It’s a shame, really, because when it comes to parenting “science”, we need interdepartmental cooperation. As someone who has read research from a variety of fields on infant feeding, I can attest that hardly anyone is listening to anyone outside of his or her field. Even within the medical field, there’s stuff happening in gastrointestinal journals that is barely referenced (or likely noticed) by those who read Pediatrics. It’s a real shame.

2. Personal bias is universally prevalent

No matter how open-minded you may be, it’s very, very difficult to stop your own experience from coloring your opinions. This happens on a subconscious level, so while you might make a concerted effort not to do so, you’ll have visceral reactions to certain ideas which will in turn inform your point of view. For example, last week, we interviewed a well-respected expert on fatherhood. He was a great guy with an impressive resume and plenty of relevant life-experience to boot – the ideal parenting expert, if you will. At one point, we asked him a question about what to do if your partner isn’t taking care of herself during pregnancy. I took this question to mean, “What should I do if my partner isn’t eating enough, taking care of her health, stress level; working too hard; not following doctor’s orders in regards to pregnancy complications, etc.” The expert proceeded to give a speech about making sure your wife doesn’t “let herself go” during pregnancy – i.e., what men can do to ensure that their wives/girlfriends aren’t packing on too many pregnancy pounds or forgoing the gym. Obviously, what “taking care of herself” meant to him was something quite different than it meant to me. It’s all about perspective.

As for the parents we’ve interviewed, they have all been lovely people, but they’ve also shown me how our own hangups, successes, and failures end up informing our parenting philosophies. A woman who had a successful first pregnancy in her mid-40s spoke freely about how if other women just did more yoga and ate better, they’d be able to conceive as late as they wanted to, and that there’d be no need for extra precautions or the label of “high-risk”. I bet she would have been singing a different tune had she spent seven years in fertility treatments, or actually had a high-risk pregnancy. (As I’ve had. Twice. And I did plenty of yoga.) She also had an a-hole doctor, and a wonderful midwifery experience, which made her an advocate for home-birth and low medical intervention. The things that went right gave her strong opinions, as did the things that went wrong. It’s human nature.

3. To change minds, accentuate the positive

The most valuable lesson I’ve learned from my job thus far, though, is that no matter what your experience is, you need to own it.

The company I work for is committed to showing all sides of the story when it comes to parenting issues; this has exposed me to people on every end of the spectrum. The ones who are passionately positive are the most effective speakers. I personally had no interest in cloth diapering, but after I saw our cloth diapering expert interviewed, I ran home and tried to convince Fearless Husband it would still be worth doing for our one-year-old (I abandoned the idea as soon as I saw how expensive the cute accoutrements were – that was really what attracted me to the prospect. Those diaper covers are freaking adorable). She was non-judgmental, sweet, warm, and so excited about how she covered her baby’s ass that it was infectious.

The ones who live in a space of negativity come across as overbearing and unlikeable. They may convince someone to change out of fear or insecurity, but I believe that in most cases, they end up simply preaching to the choir. The people who are not already following their philosophy feel judged and condemned; that’s not a healthy space in which to make changes.

Once I realized this, I began worrying. As bottle feeders, we spend so much time defending ourselves; fighting against untrue stereotypes; struggling with guilt and fear and grief over not being able to breastfeed, or not being able to conform to what society has decided is Good Parenting.

Defending. Fighting. Struggling.

Not very positive words.

Which brings me to the end of this post, in which I will implore you to start using some positive words in regards to bottle feeding. Doing so is not anti-breastfeeding; it’s pro-doing- what’s- best-for-your-baby-and-you (not a catchy slogan, but I’ll work on it). I’m working with the brilliant team over at Bottle Babies to create a video using our beautiful combo-fed, exclusively pumped-fed, tube-fed, and of course formula-fed kids to show the world that bottle feeding can be a beautiful, strong, healthy choice. It’s time to give ourselves permission to feel proud of our method of feeding, whatever that method happens to be.

We’re trying to keep the details a bit under wraps for now, so if you are interested in participating (it would require taking a specific type of photo of your kiddo or kiddos) just email me at formulafeeders@gmail.com and I will send you the details.

I hope some of you will be willing to take a stand, because what could be more fearless than telling the world that you don’t have to feel guilty or incomplete – ah crap. Scratch that – what I meant to say is, what could be more fearless than telling the world that you feel proud and complete as a bottle-feeding mother? (This turning negativity to positivity is harder than it looks, people.)

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