It’s Not About the Brelfie

For obvious reasons, I get excited whenever the media takes notice of how formula feeding parents are feeling.

That’s what happened yesterday, when the media (and my email, Twitter and Facebook feed) exploded with the news of a new campaign meant to fight back against breastfeeding pressure, using the hashtag “#bressure”. When I first read the articles about the movement, I noticed the positive (attention to the experience of “failing” to meet breastfeeding recommendations) and ignored the references to the “brelfies”, breastfeeding photos which apparently spurred the campaign in the first place. I even sent a letter to the creators, praising them and asking if the FFF community could contribute in some way.

But as the day wore on, red flags started popping up. First, a fellow blogger alerted me to the fact that the survey conducted by the Bressure movement alluded to breastfeeding selfies as “sexualized”. Then, every single article I read focused on how these (apparently sexualized) “brelfies” were directly causing pain and suffering to bottle feeders. Instead of talking about the systemic issues that create a cycle of guilt, fear, and competition, we were once again dragging the conversation down into the mommy-war gutter, pitting woman against woman, and continuing the seemingly endless divide between breastfeeding and formula feeding moms.

This is not progress.

I’ve run a modestly large international community of formula feeding parents for the past six years, and I know several truths:

1. Formula feeders are a diverse group, just as breastfeeders are a diverse group. There are militant, intolerant formula feeding parents who truly do believe that women shouldn’t breastfeed in public, just as there are militant, intolerant breastfeeding mothers who believe formula feeders are selfish, ignorant, and useless. I wish we could vote them all off the island, but alas, such is life. The problem is that we’re letting these factions monopolize the conversation. This is EXACTLY why we started #ISupportYou, to which there was a rather vocal backlash from the intolerant/militant faction, on both sides.

2. The media loves drama. It is so much more fun to blame “brelfies” for the pain we formula feeders endure, because then the extremists come out of the woodwork and create mile-long comment sections, boosting your traffic for the next few days. It is also easier to get inflammatory quotes when nuance is ignored. Nuance doesn’t get web traffic or media attention. Trust me on that one; I speak from experience.

3. Seeing breastfeeding photos is undeniably difficult for those of us who wanted to breastfeed and couldn’t, or feel conflicted about our choices. When we’re feeling vulnerable and judged, it can definitely feel like that model/celeb/Facebook friend’s breastfeeding selfie is intentionally meant to twist the knife a little deeper. But that shouldn’t stop a mom from posting a breastfeeding photo, any more than you should refrain from posting a shot of your newborn when your second cousin is struggling with fertility issues. Both of you have the right to your feelings – your pride, her grief. (That said, there’s the social media-era problem with all of us comparing ourselves to others, posting things we’d never say to someone’s face, and basically acting like insensitive jerks every time we hit “post”.)

4. The breastfeeding selfies themselves are not the problem, but the  ”#breastisbest #breastfeedingmomsrule #whatsyoursuperpower hashtags can be construed as an attack on formula feeding moms. That’s not me telling you to stop doing them, just explaining why the photos might hurt your best friend who switched to formula three weeks ago. That is not me telling you that the cause of normalizing breastfeeding isn’t important, just explaining why there might be better ways to achieve the same goals without adding to the conflict. Just like this latest “bressure” video series could have had a hugely positive impact, if the impetus behind it didn’t sound like bitterness and jealousy and a who-has-it-worse competition.

5. There’s enough anger, misunderstanding, and generalization on both sides of this debate to fill several football stadiums. When the media chooses to focus on something trivial (“brelfies” – for the love of god, who though of that term) instead of the real issues, we all lose. Personally, it makes me feel like I might as well jump in my DeLorean and head back to 2008, because what the hell have I wasted the past 6 years of my life on?

6. The top reasons that formula feeders are angry, based on my totally unscientific, not-peer-reviewed but at least peer-collected research, are the following:

We are made to feel like inferior mothers by medical professionals, websites, fellow moms, lactation consultants, mommy-and-me group leaders, and the media.

 

We get no guidance or education on bottle feeding from professionals, and when we seek it out, we get conflicting info peppered with constant reminders of why we really should be breastfeeding, so why even bother attempting to find the best type of formula, since they’re all crap, anyway?

 

The reasons that breastfeeding advocates and the media give for us “failing” to meet their recommendations are so far from our lived realities, it’s hard to believe we exist in the same dimension.

 

Everything having to do with babies these days – from conferences to books to radio shows – focuses on breastfeeding. If bottle feeding is mentioned, it’s typically in the context of Things To Avoid At All Costs Unless You Really Have to Go Back to Work In Which Case You Should Just Pump or At Absolute Worst Use Donor Milk.

 

Yes, there are many breastfeeding advocates who come to troll on our pages and provoke our anger. And yes, there are formula feeders who will do the same on breastfeeding pages. Ignore these people. They do not matter. There are more of us middle-ground, moderate folks than there are of them.

 

While mom-to-mom cruelty is certainly a part of the problem, we know that there’s a much larger battle to fight – the battle of scientific illiteracy and paternalistic advocate-physician/researchers who are blinded by a religious belief in breastfeeding. If the bullies didn’t have certain unnamed, infamous physicians leading their charge – people who encourage the shaming and ridiculing of formula feeding parents – they wouldn’t have so much power. If society had a better understanding of the reality of infant feeding research, and could acknowledge that correlation and causation are two different animals, it would take away the fear and guilt, on ALL sides.

We just want to be equal with you. Not better. We’re not even asking you to think that formula and breastmilk are equal – that’s a question of science, of risk/benefit analysis, and individual circumstance. All we are asking is that we do not equate the type of liquid going into our children’s bellies with how much we love them, or how bonded we are with them, or how strong/capable/dedicated we are as parents.

 

This is not about photos. This is not about who has it worse. This is not even about breastfeeding and formula feeding, anymore. It’s about how we view motherhood as a competition, how the powers that be monopolize on this competition, and how the media loves to encourage it. Instead of focusing on brelfies or bressure, let’s get the hell off Instagram and start making an impact in our own communities, with our own friends and fellow parents. Ignore the hype, and focus on the help.

A picture tells a thousand words. But they don’t have to be negative ones.

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“Mothers deserve better”: An interview with Dr. Christie Del Castillo-Hegyi

Dr. Christie Del Castillo-Hegyi, MD, is a mother – and a physician- on a mission. Since she began her blog and Facebook page a few months ago, she’s become a hero to over 10,000 parents who have experienced insufficient milk or delayed lactogenesis II (the process of breastmilk “coming in” after birth). She has been tirelessly advocating for better safeguards for breastfeeding mothers, and fighting against the dogma that insists that supplementation is detrimental to a baby’s health. 

I’m honored to bring you this interview with Dr. Del Castillo-Hegyi. Her opinions are controversial, and I really admire her bravery, and how she’s turned a negative personal experience into a plea for change. Before we make blanket recommendations that force women to weigh their gut instinct against the fear of recriminations from medical professionals and hospital staff, it’s essential that we look at ALL the research- without bias, without blinders, without fear. 

- The FFF

“Mothers Deserve Better”:

An Interview with Christie Del Castillo-Hegyi, MD.

FFF: Your blog and Facebook page are called “Insufficient Breastfeeding Dangers”. What are the dangers of insufficient feeding in a newborn, exactly?

CDCH: The known potential effects of insufficient feeding are dehydration, low glucose, elevated bilirubin (jaundice) and high sodium.  All in all, those laboratory markers make up the syndrome of starvation.  Dehydration, if extreme enough, can cause decreased circulating blood volume, low blood pressure, and decreased circulation to the brain.  This can cause brain injury and even death.  In animal studies, thirty minutes of loss of circulation to the brain can cause widespread brain cell death.

 

Extreme dehydration results in hypernatremia, or high sodium, because as a baby loses water, the sodium will become concentrated.  Their brains can experience contraction similar to dehydrated fruit, which upon re-expansion through rehydration, can result in brain swelling and irreversible brain injury.  It has been documented in the literature that hypernatremic dehydration can result in brain swelling, brain hemorrhage, seizures and even death.

 

It is not clear how long a child can tolerate exclusive colostrum-feeding before they develop hypoglycemia.  I have had one mother whose child seemed dissatisfied from exclusive colostrum-feeding for only one day and was found hypoglycemic by the second day.  It is difficult to know what the typical time to developing hypoglycemia of an average exclusively breastfeeding child because glucose is not routinely checked in babies without a diabetic mother or other traditional risk factors.  Hypoglycemia eventually happens to all babies if they do not receive enough milk through breastfeeding either due to poor supply or poor latch.  EVERY article in the known medical literature that has studied newborn hypoglycemia shows evidence of harm in the form of abnormal MRI findings and decreased long-term cognitive outcomes.  A low glucose is typically cited as a glucose level of less than 45, even though some newborns may exhibit few signs of distress even at this level.  Signs of a hypoglycemic newborn is agitation, frantic feeding, inconsolable crying or lethargy.

 

Lastly, insufficient feeding can result in a third dangerous condition, called hyperbilirubinemia or jaundice.  A bilirubin of greater than 15 is considered abnormal in the literature and has been associated in multiple studies around the world with a higher risk of autism relative to newborns who don’t experience high bilirubin levels.  One study refuted these findings and it came from the Kaiser system, which is a Baby-Friendly hospital, where exclusive breastfeeding from birth is encouraged.  They produced a study that was well-done but was thousands-fold smaller in size that the largest study, which showed a positive correlation, in Denmark, where they studied the ENTIRE newborn population over 10 years, which included over 700,000 newborns.  The Denmark study found a 67% higher risk of autism in jaundiced newborns.

 

That being said, I don’t want to worry every mom whose child had jaundice.  Not every jaundiced newborn has a level above 15.  Also, not every child who develops a level above 15 will develop autism.  Autism is still a genetic disease.  I believe babies who are born with a lot of autism genetics, as predicted by having lots of scientists, mathematicians and engineers in their families, who experience a physiologic insult, such as lack of oxygen to the brain and jaundice (both demonstrated in the literature to be associated with autism) may go on to have the disabling condition of autistic spectrum disorder.

FFF: What sparked your interest in this issue?

CDCH: My newborn son developed hypernatremic jaundice and dehydration because I was assured by the breastfeeding manuals that there is always enough milk in the breast as long as I keep breastfeeding.  I was told that, “he would be hungry” and that my “latch was perfect” by our lactation consultant the day we left the hospital.  No one ever told me it was possible for a child to become dehydrated and unconscious because there was not enough milk present.  We were told to count the diapers but how wet is a wet diaper?

 

My son lost 15% by the third day, the day after discharge and my pediatrician must not have calculated the percent lost because he gave us the option of continuing to breastfeed and to wait for the 4th or 5th day.  I realized when I was watching my son get an IV that what I did must be common and that other mothers must be experiencing this horror too.  I thought, “What must my son’s brain injury look like and why hadn’t I heard of this before?”  Three-and-a-half years later, I found out what his brain injury looked like.

 

What I saw with my own physician- and mother-eyes was the slow torture of a newborn child.  Babies who are asked to endure hours of frantic feeding without compensation of milk, otherwise known as “cluster feeding,” are experiencing agony.  No textbook, lactation consultant or physician will ever convince me otherwise.  To this day, the description of what I saw is embedded in every breastfeeding manual as normal and vital for the stimulation of milk production.  We are systematically telling new mothers to ignore their child’s hunger cues by telling them there is ALWAYS enough colostrum and by scaring them into withholding formula even when a newborn needs it.  THAT is why newborn dehydration will never go away with simply increasing breastfeeding support and follow-up appointments.  Unless a mother is given the knowledge about the potential harms of insufficient feeding and the right to feed her own baby, newborns will continue to experience these complications and be hospitalized for it every day.

FFF: When you began researching the topic, was there anything that surprised or shocked you?quotescover-JPG-66

CDCH: I began researching the topic shortly after receiving our son’s formal diagnosis of autism, which was February, 2014.  I first studied jaundice and autism and was surprised that there were so many studies that linked the two conditions, because I had never heard of the risk factor listed in the patient literature on autism.  I wondered why a modifiable risk factor would not be heavily attacked in the face of an epidemic.  I believe it is because it is linked to breastfeeding.

Breastfeeding has enjoyed an untouchable status in the medical community.  So much so that no part of it as outlined by the lactation community has been challenged by the physician community.  We assumed because it is associated with breastfeeding, what ever the guidelines are must be safe, despite evidence that many newborns on a daily basis get admitted for dehydration and jaundice from exclusive breastfeeding.  Unfortunately, any challenge is quickly met with an accusation that the individual is “anti-breastfeeding” or “pro-formula,” when in fact, perhaps it may simply be a challenge like mine, whose purpose is to keep the newborn safe from harm.  I am surprised by the lack of activism by the medical community to reduce or stop the incidence of a horrible, life-threatening and brain-threatening condition that can be prevented with informing mothers of these complications and a few bottles of formula to keep a child out of the hospital.

quotescover-JPG-42I was surprised to find out that we really haven’t exclusively breastfed from birth for millennia before the creation of formula.  If that were so, indigenous cultures that have no access to formula currently would be doing so nearly 100% of the time.  In fact, there is no evidence that we have widely exclusively breastfed from a single mother at all.  According to a review of the history of breastfeeding written by an IBCLC, lactation failure was first described in Egypt in 1550 B.C.  Wet nurses were often employed to feed newborns whose mother could not lactate.  There are modern day cultures where babies are breastfed by a community of mothers, not just one mother.  Also, the breastfeeding literature is rife with articles showing how problematically low exclusive breastfeeding from birth is all around the world because most cultures give what they call, “pre-lacteal feeds.”  These moms probably just call it “feeding.”  Moms all over the world recognize that their children may need more than what is coming out of the breast and they have populated their countries on the tenets of feeding their children what they need every day.  It wasn’t until the breastfeeding resurgence in the 1980’s and the codification of exclusive breastfeeding from birth through the Baby-Friendly Hospital Initiative of the World Health Organization written in 1992, that we started feeding newborns colostrum-only during the first days of life in the hospital.  This was written primarily to counteract the dangerous feeding of formula prepared with contaminated water to babies in the developing world, which was an important public health endeavor.  However, the guidelines to exclusively breastfeed for 6 months largely ignored the common possibility of insufficient milk production experienced by many mothers.  So feeding newborns without supplementation only began in the 1990’s.

Nurses who worked in the newborn nursery in the 1980’s account that newborns were supplemented from the first day of life with 2 ounces of formula.  Most newborns tolerated these feeds and did not vomit it as widely claimed by the lactation community.  I found that the newborn stomach at birth is not 5 cc, as claimed by the lactation community.  It is in fact roughly 20 cc’s or 2/3rds an ounce, as summarized by a review of 6 different articles looking at actual newborns.  This is also the static volume of a newborn stomach and may not account for peristalsis, which may allow a newborn to accommodate more.  I discovered that it is quite implausible that the stomach can grow 10 times its size in 2 days and that a one-day-old newborns can in fact drink 2 ounces in one meal without vomiting at all.

Many moms asked me, “How much weight CAN they lose?” and “What DOES my newborn need?”  I looked again to the literature looking for evidence showing the safety of weight loss in newborns and NOT A SINGLE ARTICLE showing that 10% weight loss over 10 days is safe in every newborn, which is the current standard of care.  This teaching has been accepted for decades now.  To answer the second question, I sought out what a one-day-old’s daily caloric requirement was and what the caloric content of colostrum is.  I found that a one-day-old’s caloric requirement is the same as that of a three-day-old’s, because they have the same organs and same activity all three days.  A one-day-old newborn needs 110 kcal/kg/day and colostrum has 60 kcal/100 mL.  I must have done this calculation by hand 20 times because I found that this resulted in a one-day-old needing 2.8 ounces of colostrum per pound per day .  A 7 lb child would need 19.6 oz of milk in one day.  I confirmed this finding because I gave my 5.5 lb twin girls free access to supplementation and they each took 2 oz every 3 hours on their first day, a total of 16 oz.  They only gained 1 oz! That leaves 15 oz going completely toward their metabolic activity.  For them, they required 2.7 oz/lb/day.

How much actual science and observation of actual babies and safety data was done to come up with the breastfeeding guidelines?  There are many articles that show that unlimited supplementation can reduce breastfeeding duration, which is why formula is withheld from babies, but none that showed this practice was safe for the baby’s brain in the long run.  We have no idea what threshold of weight loss is in fact safe for a baby’s brain, because it has not been studied.  While babies’ bodies can endure days of underfeeding, their brains cannot.  That is what I am asking the scientific community to study.

FFF: Do you think that medical professionals are afraid to say anything that could be construed as “anti-breastfeeding”? How have your peers responded to your work in this area?

CDCH: Yes, medical professionals are afraid to say anything contrary to what the lactation community accepts as true because they do not want to be perceived as “anti-breastfeeding” or “pro-formula.”  Being “pro-formula” or “formula-sponsored” is a common accusation that I receive despite all the “pro-breastfeeding” instruction that I provide.  People have assumed that if you are against any part of the breastfeeding prescription, you MUST be against breastfeeding.

I am absolutely pro-breastfeeding.  I am absolutely AGAINST starving a child to achieve it.  I have received quiet support from several of my peers, but mostly silence for the majority.  I believe colleagues who are silent are incredulous or shocked or afraid.  I can’t truly know.  I can understand it because I am a physician and we are taught to stick close to the pack.  I am literally running away from it.

Until there is data from a credible and impartial source like the CDC or the Joint Commission, I will not have the proof that the Baby-Friendly Hospital Initiative is causing long-lasting harm.  There is already plenty of harm that has resulted locked in the hearts of many mothers who experienced this trauma.  I hope moms from both our Facebook sites will be willing to help advocate for increased safety for newborns by submitting written and/or video testimony on how the BFHI harmed them and their child.

FFF: What sort of response have you received from publishing your blog and Facebook page? 

CDCH: Outrage from breastfeeding moms and opposition from most lactation consultants except for a loved few, two of which fully recognize the harms of insufficient feeding to baby’s and their moms.  However, the ones I live for are the responses from moms who say that this happened to them and their babies either were harmed, hospitalized or were luckily saved from harm by an independently minded mom, nurse or other individual that told them their baby was hungry and needed a bottle.  These moms write to thank me for validating what happened to them and for telling them that this was not their fault, that what they saw was real and that this should never happen to any mother and child.  I have received messages from moms experiencing what I describe in my letter in real time and I have helped those moms advocate for their child, even when their professionals were bullying them to keep withholding formula!  It’s crazy.  What are we doing to our newborns?

What I feel most disappointed about is the lack of response I have received from the Executive Committee of American Academy of Pediatrics who I have been trying to contact for at least 6 months.  No response from the organization that is supposed to protect our newborns.  So I decided to inform the public on my own.  At first I was afraid.  Now I am not.

FFF: Have you endured any personal or professional attacks due to asking these tough questions about our current protocol for early breastfeeding?

CDCH: Tons.  People on the internet can act with cruelty because they don’t have to suffer any consequences.  I try not to let it get to me because I know it comes from a place that is likely sincere like mine, a mother trying to protect her newborn from harm.  Some mothers perceive my ideas as harmful, likely because the thought of starving your child is so horrible, I get the most harsh messages from breastfeeding moms, often moms whose children developed pathological weight loss.  I haven’t received too many challenges from physicians though, interestingly enough.  At least among my colleagues on Facebook, I have received supportive messages.

FFF: In an ideal world, how do you think hospitals could alter their procedures to better protect babies and mothers from the dangers of insufficient breastfeeding?

CDCH: These are my core recommendations:

1) Instructional videos on manual expression to check for the presence of colostrum.  Mom should also be instructed on listening for swallows to detect transfer of milk.

 

2) Pre- and post-breastfeeding weights to ensure transfer of milk and identify newborns at risk for underfeeding.

 

3) Calculation of the 7% weight loss threshold at delivery so that a mother knows when supplementation may be needed, which can be posted in her room.  The most critical clinical data an exclusively breastfeeding mom needs to know is the percent weight loss of her child.

 

4) Universal informed consent and thorough counseling on the possibility of underfeeding and jaundice due to delayed or failed lactogenesis and giving mothers permission to supplement their child if they go under the weight limit at home using a baby scale. Mothers must know the signs of a newborn in distress including hours of feeding continuously, crying after unlatching, and not sleeping. Most of all, a mother should be advised to check her supply by hand-expression or pumping to ensure that her child is in fact getting fed.  If little milk is present, she should be given permission ahead of time to supplement by syringe with next-day follow-up with a pediatrician and lactation consultant to assess the effectiveness of technique and transfer of milk if such an event arises.

5) Uniform daily bilirubin (abnormal total bilirubin > 14) and glucose checks (abnormal glucose < 45) for exclusively breastfed infants who are losing weight or who have any degree of jaundice.  Both these values are critical to detect physiology that can cause brain injury.

6) Twice daily weight checks in the hospital and at home until lactogenesis and consistent milk transfer has been established with a mother-baby dyad.  These can be plotted before discharge to predict the expected weight loss the day after discharge if mother’s milk does not come in.  A mother can check the weight at home and supplement if the child reaches the weight loss threshold.

7) Detailed instructions on supplementation only after nursing to continue the stimulation needed for milk production.  Supplementation should be a choice and be accepted and supported by the medical community as a patient right.  A mother has the right to feed her child above all goals the medical community has for her.

8) A breastfeeding safety checklist to reduce medical error in the care of a mother and exclusively breastfed newborn.

 

Lastly, my advice for new mothers at home is to have an experienced parent around for the first week to help.  Parents need sleep and they don’t get much in the postpartum period.  Additionally, experienced parents know the look and sound of a child who is hungry or in distress.  The child’s wishes should be honored.  I believe in the human rights of a newborn to be fed what they need because following the alternative can lead to what my son experienced.

FFF: Your page grows in popularity every day. Have you been surprised at how many mothers have been affected by this issue?

CDCH: I am not surprised by how many mothers have experienced this issue.  Mothers have been experiencing this for 2 decades now since exclusive breastfeeding from birth has been the mandate.  This is the first that the experience is being made public because mothers have been uniformly shamed for having their child go through this.

Even now, people still post comments that blame me for not knowing, for not producing enough milk, for not seeking out enough help when the entire teaching by the lactation community prevents a mother from knowing this is possible and the standard of care does not detect what is coming out of a mother’s breast.  We have been taught to abandon responding to a baby’s cry in order to achieve exclusive breastfeeding and rely instead on weight checks and bilirubin levels to determine “medical necessity” for supplementation.

What are we doing with our newborns?  What are we doing to our mothers?  It breaks my heart every day the things mothers have told me about inadvertently starving their newborns.  They all sought help and all followed the instruction of their providers while seeing that there was something wrong with their child.  But they were told breastfeeding is always enough as long as your child is producing diapers.  What we are doing is NOT enough. These are the most well-intentioned and motivated mothers who do this. They read parenting books, attend classes and follow their doctor’s orders like I did.  I was in the hospital for a whole 48 hours while my son was receiving nothing for me!  Then I was at my pediatrician’s office the next day, at a lactation consultant’s office the day after and in the hospital by that evening.

Mothers are being led astray by the current breastfeeding dogma and being led to hospitalize their precious babies.  These mothers deserve better.

Vist Dr. Del Castillo-Hegyi’s Facebook page for more information: https://www.facebook.com/insufficientbreastfeedingdangers?fref=ts

 

 

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.

A slightly curmudgeonly rant about the drama over Save the Children’s “Superfood for Babies” campaign

The problem with writing a post which criticizes an organization which strives to help starving kids is that it makes you feel like the Grinch. Or Gargamel. I feel like I should be stroking an acrimonious cat and arching a pair of overgrown eyebrows inward.

Save the Children does a lot of wonderful things for children in dire straits, and I don’t want to come down on them too hard. And in many respects, I applaud their recently announced “Superfood for Babies” initiative. I do believe that breastfeeding is a hugely important part of improving childhood mortality in resource-poor nations, and the report supporting the program offers some excellent perspective on the challenges of raising exclusive breastfeeding rates in these areas.

In public health circles, there’s a lot of discussion on messaging – how to make PSAs culturally appropriate, sensitive, and effective. The thing is, this doesn’t only hold true for at-risk groups – it also applies to the middle-class factions of western nations. It’s just as ineffective (and inappropriate) to try and graft a message addressed to people living in tribal societies with problematic water sources onto a secretary in suburban Iowa as it would be to do the opposite. Yet, this is what happens – repeatedly – in our international discussions of breastfeeding. (Incidentally, this is at the root of my beef with Unicef and WHO, and why I feel it’s necessary to amend the Baby Friendly Hospital Initiative set forth by those organizations to be more culturally appropriate to developed, Western societies.)

This brings us to my scroogey analysis of the “Superfood for Babies” campaign.  I would encourage everyone to read the literature – it offers some truly excellent insight into the specific issues at play in a variety of developing nations, and makes it clear (whether or not it intends to) that formula is not the only barrier to encouraging exclusive breastfeeding. In some cultures, there are beliefs that breastfeeding for the first few days of a babies life is detrimental; in others, women feel pressured to produce as many babies as possible, thus making the fertility-restricting nature of breastfeeding a downside; and in others, it’s not formula which is used as a supplement but raw animal milks or concoctions of grains.

Save the Children (STC) did a lot right with this report. They addressed the need for social change; advised that governments subsidize breastfeeding women so that those in unstructured agricultural jobs (which don’t exactly come with a 401k or paid maternity leave) don’t need to return to work immediately, and have to choose between making a living and feeding their babies; and they press for better education and involvement from medical workers and midwives. I think their motives were great, and they did their homework.

Unfortunately, in their excitement, they lost perspective in three key areas…

1. They were (intentionally or unintentionally) vague about the research

Look, I would never argue that breastfeeding isn’t the best choice – by far – for babies in places where food is scarce, infection and disease runs rampant, medical care and antibiotics are severely limited, and the water source is questionable. Formula feeding is dangerous in these settings. But since breastfeeding advocates and orgs like WHO have made breastfeeding a global issue, we have a responsibility to be honest about what our body of research actually says. There are numerous instances in the STC report where claims are simply not held up by their citations. For example, this quote, on page vii of the report’s introduction:

It is not only through the ‘power of the first hour’ that breastfeeding is beneficial. If an infant is fed only breast milk for the first six months they are protected against major childhood diseases. A child who is not breastfed is 15 times more likely to die from pneumonia and 11 times more likely to die from diarrhoea[2]. Around one in eight of the young lives lost each year could be prevented through breastfeeding,[3] making it the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths[4].

Let’s take a closer look at the citations. The first one, #2, is from a UNICEF report on diarrhea and pneumonia- not a study, but a report. So it took a bit of digging to see exactly where they were getting their data from. I *think* this figure comes from a table attributed to a Lancet piece, which “estimated”  that “Suboptimum breastfeeding was… responsible for 1·4 million child deaths and 44 million disability-adjusted life years”. I couldn’t get the full study on this one, but again – it was an estimate, most likely based on other studies – not hard data.

Citation #4 is the one that’s bothersome, however (#3 is just a footnote with the definition of “exclusive breastfeeding”). The sentence “making it the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths” is most likely read as “breastfeeding is the most effective way to prevent child death”. That’s quite emotive. The citation leads you to a Lancet paper on child survival, which does have some dramatic data and charts regarding the interventions which would most reduce infant mortality in the developing world. Breastfeeding is shown to offer the most dramatic reduction in risk- but there’s one important point to consider: while this report focuses on death in children ages 0-5, the majority of these deaths occur in the first few months of life. Exclusive breastfeeding, as opposed to mixed feeding or exclusive feeding of substitutes including goat or buffalo milk, paps, or formula (important to note that in many of the countries STC is concerned about, traditions include feeding neonates animal milks or solids within hours of birth – so I think it’s arguable that the issue here is the risk of giving a baby anything but breastmilk via the breast, rather than breastfeeding being the “magic bullet” the report dubs it to be. Otherwise, we probably wouldn’t see consistently poor outcomes in mixed-fed kids, as a “magical” substance would compensate) is going to reduce the risk of infections that cause death in very young babies. In other words – if the most deaths are in newborns, and breastfeeding saves newborns more than any other interventions like vaccines, clean water, etc – then there will be a disproportionate representation of “babies saved by breastmilk” in the results. This is not to say that breastfeeding isn’t an incredibly worthwhile and effective solution to reduce infant mortality, but it’s a bit of a stretch to suggest that breastfeeding alone will be the most effective intervention for ALL childhood deaths, which is exactly what the STC report does.

2. They didn’t consider the societal implications of their recommendations, beyond the scope of infant health

I was taking notes as I read the STC report, and my heading for the section which included this quote was “OMGOMGOMG”:

Many women are not free to make their own decisions about whether they will breastfeed, or for how long. In Pakistan, a Save the Children survey revealed that only 44% of mothers considered themselves the prime decision-maker over how their children were fed. Instead it is often husbands or mothers-in-law who decide….

 

….To overcome harmful practices and tackle breastfeeding taboos, developing country governments must fund projects that focus on changing the power and gender dynamics in the community to empower young women to make their own decisions.

Changing the power and gender dynamics sounds like a fantastic idea, and I would support any program that attempted to do this. But STC has to realize that “empower(ing) young women (in developing countries) to make their own decisions is a complex and uphill battle that extends far beyond infant feeding. I fear that by placing an emphasis on UNICEF-lauded solutions like warning labels on formula cans/making formula prescription-only, and on educating fathers/elders on the importance of breastfeeding using the current overzealous and often misleading messages, in these countries – places where, all too often, females are already considered “property” and subjected to any manner of injustices – it will create an atmosphere where women who are physically unable to breastfeed will be ostracized, shamed, or penalized. I agree that we need to empower women, but I think that we also need to be verrrry careful about presenting “suboptimal breastfeeding” as a risky behavior in certain cultures.

In another section, the authors report that breastfeeding rates have gone up in Malawai despite poor legislation on maternity leave, breastfeeding rights, etc. – that these improvements are based solely on strict implementation of WHO Code. I’d like to be reassured that as women are being given no option other than breastfeeding without any of the protections which would make EBF feasible while working, this isn’t having a deleterious effect on their lives. It’s wonderful that breastfeeding rates are up, but what about correlating rates of employment, poverty, and maternal health?

3. They failed to differentiate between resource poor and resource rich countries

I’ve seen a wide range of opinions on the STC program online in the past few days. Most of the drama is over British media reports which mention putting large warning labels on all formula tins – not just the ones going to resource-poor countries. Some feel that these labels will cause unnecessary upset in the West; others argue that when it comes to saving starving/sick third-world babies, privileged mommy pundits should STFU. And others keep insisting that the STC report was misrepresented, and that the labeling stuff was a minor part of the larger plan and shouldn’t be harped on.

All of these arguments are valid, and yet all are missing the nuance necessary to have a productive conversation. We need to realize that not breastfeeding has quite different implications in certain parts of the world. We also need to acknowledge that a woman’s rights are important no matter how much money she has or where she lives, and that we all have a right to stand up for what we believe – it’s rather useless to play the “eat your dinner because children are starving in Africa” game, and rather un-PC as well.

But STC also needs to take responsibility, here. The fact is that the report does not really differentiate between resource-poor and resource-rich countries when it is discussing WHO Code and formula marketing.  For example, this passage on p. 45 describes laws which STC wants implemented worldwide:

Breast-milk substitute companies should adopt and implement a business code of conduct regarding their engagement with governments in relation to breast-milk substitutes legislation. Companies should include a public register on their website that outlines their membership of national or regional industry bodies or associations, any meetings where the WHO Code or breastfeeding is discussed, and details of any public affairs or public relations companies they have hired, alongside the nature of this work… Any associations (such as nutrition associations or working mothers’ associations) that receive funding from infant formula companies should be required to declare it publicly. In addition to this information being made publicly available on the websites of individual companies, the International Association of Infant Food Manufacturers should publish a consolidated record of this information, updated on a quarterly basis.

Personally, I think the money spent on a “governing association” in order to police this policy would be better spent on funding literacy programs to help parents read the labels we’re arguing about. Some of these countries have literacy rates of like 30% – which makes me wonder exactly who the labels are geared to, if not the Westerners for whom formula feeding is far, far less of a risky endeavor.

Don’t mistake me – the evidence given in this report about the shady practices of formula co’s is alarming. There needs to be something done about unethical marketing practices in parts of the world where information is limited, education is a true privilege, and options are a joke. Yet, in the STC report, there is ample (and quite good) evidence that the unethical efforts of formula companies are only one slice of a thick-crust, Chicago-style pizza. There’s a lot of gooey, barely distinguishable elements which all combine to make a rather heavy problem, and focusing so much on one of them will leave you with the policy equivalent of Domino’s.

Further, the situation with breastfeeding in the developing world is markedly different from what’s going on in Great Britain, the US, Canada, and so forth. The online arguments are proof of this. I’ve seen the same people who argue that breastfeeding is a global issue turn around and tell concerned Americans and Brits that they have no idea what’s appropriate in Peru or Ghana. This may be true, but so is the reverse. International groups like STC have to remember that when they release papers making global recommendations about infant feeding, that they are inviting commentary from a global audience. That’s why we can’t make blanket statements about infant feeding and child health, or try and implement the same rules in order to get the same results. We wouldn’t go into a rural village where families share a 300-square foot hut and start lecturing them about the dangers of co-sleeping, and yet we assume that the same one-size-fits-all public health messaging is fair game when it comes to infant feeding. Breastfeeding might indeed be a global issue, but the type of issue it is varies greatly depending on what part of the globe you’re on.

 

Nothing changes…

Lately I’ve been frustrated. Like, mind-numbingly frustrated. It seems that every week there’s a new article on the infant feeding wars, rehashing the same points over and over, with the same battle being waged in the comments section: You’re judgmental. Yeah, well, you’re anti-breastfeeding! No I’m not, and I’m a better parent than you! Oh, really, well, I’m am MD/RN/LC/PhD and I KNOW I’m right, so shut up! You’re a lactofanatic! You’re selfish and misinformed and a threat to breastfeeding moms everywhere! Bloomberg! Hannah Rosin! Bottle! Breast! Bottle! Breast!

Shall I go on?

I’ve been blogging for nearly 3.5 years now, and I’m so damn tired. I’m incredibly grateful and proud of the community which has formed around FFF, but I don’t see anything changing. I want to do more than whine about how unfair the current atmosphere is; I want to change it. I want to make this blog unnecessary, because I’m truly sick of talking this subject to death. And I’m sure you guys are sick of hearing about it. How many times can I pick apart studies which fail to thoroughly consider the most basic notions of correlation and causation? How many ranty essays can I vomit out about the pressure to breastfeed? None of it seems to matter, because nothing changes.

I mean, nothing changes.

I wrote a book, one that took nearly three years of heavy research, interviews, and soul-sucking rewrites, hoping that it would help me reach a larger audience, and get people talking on a more nuanced level about this debate. But no one wants nuance.

And nothing changes.

I sit here at my computer, hiding behind the safety of our little community, preaching to the choir, holding myself up as fearless while I wallow in fear; the fear that people will judge me, criticize me; the fear that I will disappoint you.

And nothing changes.

Recently, an opportunity came up that might allow me to effect change in one tiny arena of this circus of insanity. It would allow me to meet with some other people who are uneasy with the way formula is being vilified. It would give me the ability to spread the message that we need better education and guidance for bottle-feeders. It might give me access to people willing to listen to ideas about tempering the Baby Friendly Hospital Initiative to be a little more palatable to those of us who must, or choose to, formula feed.

The problem is that this opportunity necessitates my associating with a formula company. They are the ones with the means to bring me to the table, to have these conversations. It makes sense that they contacted me; they have a vested interest in protecting infant feeding “choice”, and so do I. But theirs is financial, and mine is personal. I’m not naive; I know they aren’t doing this out of the kindness of their hearts.

Formula companies- like all major corporations- are out to make money. Some of the ways they go about this do not bother me – for example, I see no harm in them advertising their product. I view formula as a healthy substitute for breastmilk – certainly not perfect, not without room for improvement (because I always suspect manufactured substances always have room for improvement – that’s just the capitalist in me), and as I explain in Bottled Up, not a competitor to breastmilk. Just another option. Considering the only industry that has major restrictions on advertising is Big Tobacco, to say formula companies shouldn’t be allowed to advertise is to compare them with the manufacturers of cigarettes- a completely unfounded, ridiculous, and irresponsible comparison, in my opinion. I don’t like when they bring breastmilk into the marketing message – lines like “closest to breastmilk” should be left on the cutting room floor- but at the same time, how can we really blame them? If we are spending so much time and effort convincing society that breastmilk is the gold standard, why wouldn’t specific formulas want to be seen as coming closer to matching this liquid gold than their competitors?

But there are other ways that formula companies handle themselves that provoke a disturbing, fundamental mistrust in my gut. They want to increase their sales; therefore, it’s in their best interest if women do not breastfeed. This is a fact that’s impossible to ignore, when we see them sponsoring breastfeeding “help” hotlines and guides. I can’t help siding with breastfeeding advocates on this one: the LAST people who should be giving breastfeeding advice are the folks with a vested interest in having women turn to the alternative.

This is the point in my ongoing internal debate where I start getting all angst-ridden. Formula marketing execs need to take a long, hard look at how they are handling their accounts. They have an incredibly smart, media-savvy audience in this country-not all moms are Little Red Riding Hoods; many of us know there’s a wolf hiding behind that grandmotherly lactation consultant. Even if the breastfeeding information they are doling out is 100% useful, encouraging, and evidence-based, it is not going to be received as such.

What I find so frustrating is that formula companies are so busy trying to market to breastfeeding moms, when they have a willing and ready market base just sitting here, waving our arms to get their attention. Ban The Bags doesn’t want them hawking their wares to mothers attempting to breastfeed? Fine. More for us. Why not urge hospitals to keep the bags on hand, to be distributed only to parents who request them? Or even better, give parents the option of signing up on a website to receive the samples in the mail. Seems like a no-brainer that most moderate people could accept as a compromise.

Likewise, why should formula companies distribute pamphlets on breastfeeding when formula advice is so needed? If you’re going to spend money sending formula samples in the mail, the literature accompanying it should be about formula feeding. Not breastfeeding. Leave that to Medela or Lansinoh.

I have plenty of ideas on how formula companies could better serve us, their true customer base, and perhaps shift the cultural opinion of formula feeding away from a “competitor” to breastmilk and towards a more moderate point of view, where it is merely seen as an option for women who cannot or choose not to breastfeed. Tough distinction, but worth making. And there’s a hopeful part of me which thinks that maybe, just maybe, the formula companies also want to protect their customer base – even if it is for entirely selfish reasons.The formula companies don’t want their customers feeling ashamed to buy their products; they want us to be proudly bragging about how great our kids did on Enfasimistart. They don’t want us improperly using the stuff and then suing them later.

If I’ve learned anything in the past few years, it’s this: breastfeeding moms have a tough time in this world. But they also have a lot of respected, smart, noble individuals fighting their fight. No one believes that formula feeders need defending, so we are left to our own devices. The only folks who have a vested interested in our well-being is the formula companies, and they haven’t really done us many favors.

I’ve been thinking that maybe I can change that, though. If I can’t make headway with the breastfeeding organizations, maybe I can at least provoke some change in the companies who are making and marketing the products that feed our babies. Maybe if they hear from us – their customers – they can put some of their considerable resources and influences to good use, rather than simply pissing off breastfeeding advocates and giving them more fodder to hate on formula, formula makers, and by association, formula feeders.

This is something I want to do; something that I think could actually provoke change in a positive way for both formula feeding parents and breastfeeding moms – because we don’t have to be at cross purposes. I support infant feeding choice – that means ensuring that breastfeeding and formula feeding are equally protected, and parents are appropriately educated about whatever feeding method is right for them. I don’t see any education or protection for formula feeding parents, and no one is willing to change this. It would be great if UNICEF or the Academy of Breastfeeding Medicine wanted to listen to what I have to say, but I’m not waiting by the phone for them to call. I don’t get the impression they’re very interested in what I have to say.

While all of this sounds good in my head, these thoughts are giving me a migraine. I’m well aware that associating with the formula companies opens me up to major criticism. And yet I can’t help think that there is a major difference between being influenced by a formula company, and influencing a formula company. Being influenced by a formula company would mean having them sponsor this blog, or pay me a salary, because then my content would be soiled by bias- whether it be of the financial or subliminal persuasion. We’ve all seen how having ads or sponsors can soil the editorial style of some of our favorite bloggers; I certainly don’t blame them for it, since this blogging thing takes time and a girl’s got to eat. In my case, though, if I don’t have my neutrality, I don’t have sh-t.

But I’m not talking about being influenced – I’m talking about influencing. I’m talking about having them interface with me on MY terms, helping them move in a better direction, and walking away if I feel things are shady. I’m not sure how this is more suspect than a representative of Planned Parenthood meeting with Trojan. The former wants to advocate for safer sex, and knows abstinence is unrealistic; the latter makes condoms; if Trojan can help promote safer sex and sell more condoms due to a halo effect, it’s a win-win for both parties.

I’m opening this up to the community, because your opinions are the only ones I care about. People have been accusing me of being in the pockets of the formula industry since day one; I don’t know if it even matters to them whether I throw molotov cocktails into the lobby of Nestle headquarters, or bathe naked in a vat of Good Start. But I take my responsibility to this community very seriously, and I wouldn’t make a decision like this without your input.  Please think about this, and let me know: is it okay to associate with the formula companies on an advocacy level? Or will this destroy my neutrality, even if I vow not to let it?

Because seriously…. something has to change.

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