A public health perspective on formula use & breastfeeding advocacy – Guest Post

I’m incredibly thankful that someone in the field of public health is taking a stand on how we ignore the reality of formula use, and I really hope others will follow. We need decision-makers and influencers – physicians, scientists, public health professionals, nurses, politicians, hospital administrators – to start looking more closely at these issues, and to speak up when they see flaws in the current system. It’s the only way true change can happen.

The FFF

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A public health perspective on formula use and breastfeeding advocacy:

What we don’t say matters

 

by Hillary Kuzdeba, MPH

 

In the United States, the majority of babies will receive formula at some point during their first year. Despite what we may personally believe about the importance of breastfeeding, it is critical that medical and public health professionals keep this fact in mind when we design infant feeding educational initiatives for families. When we fail to discuss formula with families, or worse, when we purposefully withhold information on formula from them, we are doing families and infants a great disservice.

 

Today, most of the breastfeeding advocacy programs implemented in hospitals, birth centers, and OBGYN/midwifery practices utilize a two pronged approach to encourage breastfeeding. The first method, which is the active promotion of breastfeeding, is immediately apparent. Women are empowered to breastfeed through intensive educational materials, classes, consultations, and support groups. The second method is less noticeable, but important nonetheless. Here, strategic obstacles deter women from formula feeding. The obstacles include the reorientation of discussions about formula back towards the “breast is best” message, limiting access to formula during hospitalization, and generally withholding any information on formula lest it “encourage” the family to use it. Used in tandem, both methods create an environment where breastfeeding is presented as the only healthy feeding option. This is why pro-breastfeeding institutions rarely disseminate any information on formula feeding, except to mention that it is suboptimal. In these environments, families will find a myriad of resources on lactation, breastfeeding positions, latching, pumping, and other breastfeeding topics. Meanwhile, practical guides discussing formula selection, appropriate mixing, safe storage, and feeding have been almost completely eliminated.

 

The first method employed by these programs is wonderful. Most of us agree wholeheartedly that women who want to breastfeed should receive extensive support. I did, and I am so thankful for the resources that helped me breastfeed for as long as I did. But it is the second part of the advocacy approach that worries me, both as a public health professional and a mother. The strategy of withholding health information from patients and families, out of a misguided fear that more information might encourage an undesired behavior, has long been debunked by the scientific community as ineffective and potentially harmful. And yet we continue to implement this strategy in regards to formula feeding.

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Some public health researchers, advocates, and other parties may balk at this statement. They may point to evidence suggesting that placing obstacles in the path of a decision can “nudge” individuals towards a different choice. That may be true in specific instances, such as smoking or alcohol use, where the undesired behavior is recreational, unnecessary, addictive, and downright harmful. But infants must eat, formula is a proven healthy option, and breastfeeding can be very challenging for numerous physical, psychological, and social reasons. Most women in the US initiate breastfeeding. So when they do use formula, it is usually a conscious decision for reasons outside of personal preference. Withholding information from these women does not “nudge” them towards breastfeeding. A lack of knowledge about formula does not make extreme nipple pain disappear, or milk flow. It does not change a baby’s mouth structure, or eliminate a working mom’s 12 hour shift. All it does is create the impression that a parent has no option other than breastfeeding.

 

How does this strategy really play out?

 

  • When a parent who is aware of the benefits of breastfeeding still wants to talk formula, twisting the conversation into another discussion of how “breast is best” is not education – it’s intimidation. This behavior alienates and stigmatizes her, while simultaneously undermining her intelligence and personal authority. It is a form of intellectual bullying, and it delays the provision of requested education on formula feeding. When we use this approach, the message we are sending is clear: “You must not be aware that formula is a poor choice. Let me reeducate you because you clearly aren’t getting it. Maybe now you’ll come to the right decision.”

 

  • If a woman is really struggling to breastfeed and we oppose her when she requests formula, we create a power struggle with a vulnerable parent who is just trying to feed her child. This undermines her trust in us and causes anxiety. She may begin to question whether we really care about her and her infant. This can be devastating for our relationship with poor women, minorities, or other groups who already have reason to be suspicious of the medical establishment or government due to past medical and scientific abuses.

 

  • When we send new parents home with absolutely no education on even the basics of formula feeding like appropriate bottle cleaning and safe storage, we are purposefully withholding critical safety information that could potentially result in harm to an infant. Even parents who appear committed to exclusive breastfeeding should still be educated on these subjects given that most will end up using formula at some point. Assuming they won’t need this information is wishful thinking.

 

Worst of all, when we create an environment that strongly implies that we are against formula, we accidentally send the message that breastfeeding should be prioritized above all else, including the health of mother and baby. In this environment, our silence on formula use speaks volumes. It overexaggerates the risks of not breastfeeding to the point where mothers may actually endanger themselves and their babies in a desperate effort to avoid the dreaded F word. No mother should be so hesitant to give her child a bottle that the baby ends up hospitalized for extreme dehydration or malnutrition. No mother should be so afraid of formula that she spirals into depression over her inability to breastfeed. And no mother should be led to believe that formula is so risky that she is willing to turn to unscreened, unregulated human milk from an anonymous stranger on the internet to feed her child. And yet, this is happening every day across the US.

Educating families on safe formula selection, preparation, feeding and storage in no way undermines breastfeeding. If a mother is committed to exclusive breastfeeding, providing her with an extra handout on formula use is not going to change her mind. But including that same information can make a world of difference to a family who finds themselves in need of formula. When we include formula in our discussions, our classes, and our educational materials, we create a safe space that shows parents we are on their side – regardless of how they feed their baby. I think that is a strategy we can all get behind.

Hillary Kuzdeba holds a Master of Public Health (MPH) with a focus on social behavioral science, health promotion, and women’s health. Over the last few years, she served as the program coordinator for a large nursing research group at a renowned Children’s Hospital. Today, she spends her days at home taking care of her beautiful, formula-fed daughter.

A Poem by Jennifer Bagot-Woods

The following poem is by Jennifer Bagot-Woods. I’m so honored she is allowing me to share it with the FFF audience… hope you enjoy it as much as I did!

– The FFF

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“Breast is best”, everyone knows…

it’s all a little one needs to grow.

It’s how I was fed when I was a baby…

so I’ll breastfeed, no ifs, buts or maybes!

 

“Breast is best” the midwife said…

so that’s what I’ll do, it’s clear in my head.

No bottles required, except to express.

Formula is only for mums who care less.

 

“Breast is best” the researchers say.

There really is no other way…

to give your baby the best start in life.

I’ve already heard this from the midwife!

 

 “Breast is best” the mums groups agree.

With the added bonus it comes cost free!

Your baby will develop just as she should.

That formula stuff is really no good.

 

“Breast is best”, it’s really quite simple…

your baby will latch, then guzzle and guzzle…

till her tummy is full with such wholesome food…

the milk from the breast, it really is good!

 

“Breast is best” – it’s how you bond…

skin-on-skin is all she’ll want.

You’ll be so close, it’s rather nice.

This seems to be the best advice!

 

“Breast is best” – my baby is here,

I offer her mine, it’s met with tears.

I try all positions, the tricks I’ve been taught…

but the ability to suck – she has not!

 

“Breast is best” – the Health Visitors Advice.

But expressing is taking over my life.

As my baby can’t suck, we syringe every feed.

“Just keep on trying, you’re fulfilling her needs”.

 

“Breast is best” the literature reads:

“Offer her breast at every feed”.

Soon she will learn to take from you…

and the bond you forge will be so true.

 

“Breast is best” but my baby is starving.

Demanding more milk but still not latching.

My supply can’t keep up with my little ones growth.

But formula is bad, everyone knows!

 

“Breast is best” of course unless…

You try and try with no success!

That bond they promised can’t be had…

when every mealtime starts so bad.

 

When the time on the breast only frustrates…

I begin to wonder if this advice is so great?

 As my baby’s suck is already weak…

and she’s tired from simply trying to eat.

 

Each feed takes two hours – sometimes more.

Then I rush to express from breasts so sore.

I must get enough to meet her next feed.

I’m so worn out by “fulfilling her needs”.

 

I sit and reflect at the end of a day…

Feed – wind – express – no time for play…

or to cuddle and cherish my precious new baby…

this expressing regime is making me crazy!

 

I start to wonder if my milks even good…

when it’s days since I managed to consume proper food.

So I’m met with a choice difficult to make…

about what is best for everyone’s sake?

 

Do I sacrifice meals and take time to express?

I’m already exhausted and my milk supply’s less!

For weeks we have tried but the breast doesn’t work…

with a baby who plainly and simply can’t suck!

 

Then the decision is taken out of my hands…

when the amount I express can’t meet her demands.

So with feelings of guilt, and possibly grief…

we resort to formula and in disbelief…

 

“Breast is Best” is the first thing we read!

Endorsed on the packaging – advice for free!

And now the guilt is made much worse.

This whole situation feels like a curse!

 

“Breast is best” but not everyone is able.

So I make up a bottle and cry at the table.

Then my baby is hungry and it’s all that I’ve got.

And even with bottle her sucking’s not hot.

 

But she manages to chomp and take a good feed.

I watch her guzzle, for the first time with greed…

a meal that didn’t start with the option of breast.

A mealtime not spoiled with fussing and stress.

 

My feelings of guilt don’t last very long…

when I see that my baby is healthy and strong.

Then in between feeds we make time to play…

as expressing doesn’t occupy all of my day!

 

And that bond that they said breastfeeding would bring…

only starts forming when we stop the damn thing!

For the frustration and stress at the start of each meal…

is replaced by some cuddles and a peace she can feel.

 

So “Breast is best” of course unless…

all it brings is exhaustion and stress.

And looking back now with a head that is level…

formula was our godsend, disguised as the devil!

– Jennifer Bagot-Woods

 

FFF Friday: “Maybe My Better Isn’t Your Better”

Today, World Breastfeeding Week begins. There’s a lot of good that comes out of this week, but it can also be a painful, triggering seven days for those who have struggled with their infant feeding decisions. 

That’s why I was excited when this FFF Friday landed in my inbox a few months ago, because I knew it would be the perfect entry for this week.  Carly’s piece isn’t about breastfeeding or formula feeding. It’s about the terminology we use to discuss parenting choices; our inability to look outside of ourselves and our experiences, our beliefs. 

I hope people take this one to heart. I honestly believe if they did, we could stop discussing the same, old, tired issues and move on to the real work of supporting parents in concrete ways. 

It’s something to dream about, at least, on this late World Breastfeeding Week eve…

Happy Friday, fearless ones,

The FFF

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Maybe My “Better” Isn’t Your “Better”

by Carly Ceccarelli

“When you know better, you do better.” Maya Angelou

I tried to dig to the bottom of the context of this quote and was instead bombarded with legions of posts from various blogs, online groups, and message boards regarding choices in parenting and how many use this quote as not only their parenting compass, but a ‘gentle’ way of recommending that what you are doing with your child is hopelessly, utterly wrong.

Have you ever considered…..maybe my “better” isn’t your “better”?

I have been through so many seasons in life. Haven’t we all? Fortunately, I have gained some perspective from those. I have been broke and living off of fish sticks and canned ravioli.  I have been a working, single mom with not exactly a load of free time or patience. I have been a stay at home mom to an intense baby that taught me more about lacking free time and patience than being a working, single mom ever did.

As a result of seasons, we make choices. My current season is being at home full time with two children under two years old. That intense baby is now a very mobile, intense toddler.  My experience with him greatly impacted my choices with his younger sister.  Having to be a present and attentive parent to two children simultaneously impacted my choices with both children. Only having two arms and two legs impacts the choices I make every day.  Yet I am bombarded with what I “should” choose because this person or that person knows that I “know better”.

I do know better.

I know better that, for me, these are the choices that are in line with the goals my family has, all people and categories of impact considered.  I have a diverse group of friends who are all over the spectrum regarding their choices, based on the goals THEY have within their familial units.

I had all of the answers, too. I understand the need to spread the gospel of my amazing experiences and informational finds, because, heaven forbid, that person doesn’t have access to Google and would “miss out”.  I realize how very wrong I was. I realize now that there isn’t one answer for everyone in any category, and that I am showing more wisdom when I am silent because I don’t know everything, as opposed to saying something because I believe I do.

FFF Friday: “Judge Me – I Don’t Need Your Approval”

This isn’t a typical FFF Friday, but more of a guest post. I think it fits, though, because it’s coming from the same place so many of your stories come from. It’s the result of a mother’s journey.

Unfortunately, I don’t think it’s that easy to just stop caring what other people think, especially if you’re a people pleaser at heart. Like me. Hell, I was in tears the other day over some drama on the FFF Private Facebook page, because I felt like I was being misunderstood and unfairly judged. But I wish I didn’t care, and that’s why I love Michelle’s piece. It makes me want to work on this part of myself, to be more successful at letting useless hate roll off my back. 

So – I’m going to hand the floor over to Michelle, who is a lot stronger than I am. My hope for you is that you can take at least a little of her message and live it. You may not be able to stop yourself from caring what people think, but at least try and make those people ones who are worth caring about. 

Happy Friday, fearless ones,

The FFF

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Judge Me – I Don’t Need Your Approval

by Michelle Shelemay

Judging.  In the context of the “mummy wars”, feeling judged is the biggest complaint. Every decision relating to pregnancy, birth, feeding and parenting has been turned into an absolute moral choice – every decision is judged as objectively “good” or “bad”.  For some reason, people find it difficult to accept that what’s good for you, isn’t necessarily good for me. I would even say that some decisions are simply personal preferences that in the long run, have little impact beyond being convenient and what suits you.

But really, why do we care so much about what other people think?  As someone who chose to have a c-section and chose to formula feed from day 1, I’ve made decisions that are typically subject to a huge amount criticism.  Do I care? Not really.  Why should I care?  Why should I care what random people on the internet think of me? I’m very happy with my decisions.  I will almost certainly make the same decisions again, next time round. I do not need other people’s approval. For me, the advantages and benefits of both decisions greatly outweigh the disadvantages and the risks.  I do not need to prove to anyone that my decisions were carefully considered and informed. It should be a given that that’s how a normal person makes important decisions (and let’s be honest, if I was a man, it probably would be).

It’s my body, my life and my responsibility.  I most certainly do not need the approval of people who don’t know me and share no responsibility in the outcome of my decision.  Although they are personal decisions, I am happy to discuss them with people who are genuinely interested or for whom the discussion will be helpful.  However, the point is, my decisions don’t need anyone’s approval (ok, apart from the medical staff who performed the c-section) and NEITHER DO YOURS.

Let’s make it clear – there’s a difference between approval and support. I join facebook groups like Cesarean by Choice Awareness and the Fearless Formula Feeder for support and advice.  Not because I need someone’s approval or endorsement of my decisions. Of course, I also don’t make decisions entirely on my own.  I read, I seek medical advice, I talk to people who I TRUST, who don’t have an agenda and who I know have my best interests at heart. But that doesn’t include every  “alpha mama”  lurking online.

So ladies, here’s my call to you.  Stop seeking approval.  Stop feeling guilty.  You don’t need to justify your decisions to strangers. Be confident in your ability to make good decisions.  I genuinely believe that once we stop caring what people think, once we stop seeking approval for our decisions, the judging will stop. The judgers will get bored. They are seeking a reaction and as long as we give them one, they’ll continue.  Once we stop caring and stop reacting, they’ll get bored and stop.  Frankly, I find other people’s obsession with how I gave birth to or feed my child (and interest in the the respective body parts), a little sinister and weird.  And that’s something that reflects badly on them, not me.

I’m specifically addressing this to women, as this seems to be an issue that predominantly affects women.  The feminists among you will understand why – patriarchal society infantilizes women.  Questioning women’s ability to make good decisions is part of that infantilization and nowhere do we see this more clearly than in how we relate to women around pregnancy, birth and motherhood.  It’s no coincidence that we talk about the “mummy wars” rather than the “daddy wars” and it’s not just because more mothers than fathers are the primary care givers.

So here’s my challenge to you – stop caring what other people think.  Make whatever decisions are right for you and be happy with them.  You certainly don’t need my approval.

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Have a story you want to share? Email me at formulafeeders@gmail.com

 

Guest Post: I Am Not a Cow

I’m thrilled to share this post with you, from my friend Andrea Nord. Andrea is the chairperson for the non-profit organization “Bottle Feeding in Sweden” and is an admin for a Swedish Facebook group like the FFF private group, which can’t be an easy job, considering the infant feeding attitudes of that country. She’s one of the most astute, brave, and seriously awesome women I’ve had the pleasure of getting to know in this crazy sort of advocacy I’m in, and I’m glad I get to share her brilliance with you via this post (which she graciously translated into English for us). The post originally appeared on Petra Jankov Picha’s bottle feeding blog “Att Flaskmata”.

About twenty km east of Lund, in the southernmost part of Sweden, is a large natural area called Revingehed. The Swedish military uses this area for short periods for their exercises and sometimes you can hear the sounds of gunfire in the village of Veberöd where I live. But for the most part, the area is a quiet and peaceful place where hundreds of cows graze freely to keep the grass short and the grounds open. Sometimes we take a drive there for a near-cow-experience, as my kids call it. If you are lucky you may see cows on the road just when you are driving by. It’s a really lovely experience that I heartily recommend, especially now when the calves are small.

When you think of cows you might think of beautiful black and white Holsteins wandering back to the barn after a long day of grazing in the meadows. All the cows are the same, it’s just the patterns on their coats that are different. Otherwise, they all have the same needs, they all want the same things and they all do the same things all day long. There are no cows with any special needs or aspirations, except of course the famous fictional cow Mamma Moo from the Swedish children’s books with the same name, the cow who was not satisfied with just grazing and chewing. She wanted to do everything that people did, she wanted to swing and go down a slide, despite her good friend the crow’s desperate attempts to point out to her that she is in fact just a cow, and cows do not behave like humans. Period.

Source: http://9teen87spostcards.blogspot.com/2011/07/mamma-moo-cow-riding-bicycle.html

Source: http://9teen87spostcards.blogspot.com/2011/07/mamma-moo-cow-riding-bicycle.html

 

Part of what makes Mamma Moo so funny is her inability to comply with expected and “natural” cow behaviour. Mamma Moo is a.. feminist! Imagine that! And then the idea hit me – why does the WHO and our Swedish National Board of Health and Welfare assume that all women in the world are the same, that we all do the same things and want the same things? Why do people think that women don’t have different needs, wants or conditions? Why this astonishment whenever we want to do something different from the expected and “natural”?

Does the world see us women as.. cows? Because if you do not see women as unique individuals but as cows, then it is close at hand to recommend that we should all do things exactly the same way. What is “best” is then best for everyone. The word recommend is perhaps the wrong word, require is probably closer to reality. And there are many “truths” that we women are expected abide by and now we come to The Mommy Wars, which I see as the social pressure to get all women to comply to a perceived truth. You see, all of us women are supposed to do things exactly the same way!

If there was tolerance for women doing things in different ways, then there would be no reason to get all upset about it. But women do in fact want different things – some want to work, others want to be at home. Some breastfeed, others bottle feed. The nerve of them!

It’s interesting that I find it hard to find similar examples where one would try to get all men to do the exact same things or get upset if they didn’t. The mere idea is completely ridiculous, for men are seen as individuals, they are all different and they are allowed to do what they think is best. The only example I can think of, when trying to get all men to do the same thing, is when you recruit them into the army and send them out to war. Then and only then are men oppressed to all do the same thing. But in peacetime, they are all free to do whatever they want and however they wish to do it. Now I would like to end this rant with an appeal to the WHO, the National Board of Health and Welfare and all the health authorities: stop seeing us women as cows! See us instead as unique individuals capable of thinking and making decisions about what is best for ourselves and our families!

Let us be free to decide how we want to feed our babies and stop trying to round us up and herd us all into a corral. We are women, not cows.

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