Thursday, August 2, 2012

Reply turned post: The nightmarish vision of a baby-friendly hospital

Feministe, along with a few other things I've seen around the interwebs, has a hand-wringing post about New York City encouraging hospitals to adopt baby-friendly practices such as limiting staff access to formula, not advertise formula, not give free formula samples, etc. Caperton at Feministe describes this state-controlled gulag:
Starting September 3, baby formula will be a controlled substance at some New York City hospitals. Under the health department’s voluntary Latch On NYC program, 27 hospitals are literally hiding the baby formula under lock and key, tucking it away in distant storerooms and locked dispensaries like legitimate medications that need to be tracked. Nurses will be expected to document a medical reason for every bottle a newborn receives, and mothers will get a breastfeeding lecture every time they ask for a bottle of formula.
Cue lots of upset in the comments about how babies will go hungry.

My first response:

So many of these comments are ridiculously overdramatizing an already overdramatized issue. “Babies will be forced to wait an hour for a bottle!” No. I work as an LC at a hospital with these policies so let’s clear some things up:
1) You don’t want to breastfeed, you don’t. You get your bottles on admission and that’s the end. The LC doesn’t see you unless you ask to be seen for some reason, like engorgement.
2) You want to breastfeed, you breastfeed. Nurses can’t sneak formula behind your back. Before we started documenting the mother’s consent, there was a lot of “she said/she said” after the night shift left. The nurse claimed the mom asked for a bottle, the mom claimed the nurse gave it without permission. Now if there’s a bottle, everything is documented and no one can say they didn’t know.
3) You need a bottle, the nurse or NA brings it to you. There’s no “queue” and no one is waiting for an hour. The formula is in the cabinet with all the other supplies. (That is totally staff-facing by the way – it’s not like the parents ever know it’s locked up. So is the Tylenol and that’s not shaming people with headaches.) We limit the amount of formula we give per feeding in part because people will give insanely inappropriate amounts. A newborn has a stomach made to hold about a third of an ounce at birth. I have seen people give over two ounces at one feeding!! It’s considered an accomplishment by grandma that she got the baby to eat so much, but it is not good for the baby.
4) If you are asking for formula for personal reasons, we document the reason. If the baby needs it for medical reasons, we document that too. Again, this is not to shame anybody or demand they give us a good excuse, it is to push the medical/nursing staff to acknowledge that “the baby cried some” is not a reason to tell the mother “you need to formula feed or your baby will starve”. (You think people don’t do that? You are wrong.) Medical reasons to supplement include excessive weight loss, jaundice associated with poor feeding, etc.
5) No one gets lectured. The consent they sign does say that giving bottles may interfere with their STATED plan to breastfeed. That is the truth, so I don’t think there’s a big problem with it. I work with a lot of moms who choose to formula feed for various reasons, usually because they believe they don’t have enough milk. I disagree, and I explain why I don’t think that there is a medical need for supplementation. I say that while there is no medical need, it is their baby and they can decide whatever they want. Some parents hear my explanation, feel reassured, and keep breastfeeding exclusively. Some decide they want to go ahead and supplement. Their baby, their choice. So much for the heavy-handed police state – sorry if real life disappoints. I feel like so many of these comments are like a Tea Party vision of Obamacare.

My second comment:

@Caperton: “On top of that, we have arguments of Nurses are good and supportive and helpful and so this policy won’t have negative side effects vs. Nurses sneak formula and bottle-feed your baby behind your back and don’t honor your wishes, so they need extra rules. Whether it’s either or both…” It is both, and also Nurses can be pushy jerks about both breast and formula feeding (and a million other topics as well “stop picking up the baby when it cries!”) They do need extra rules. These are some of the rules.

 “…Whether it’s either or both, we still have a policy that’s based on locking up baby formula and dispensing it bit by bit like feeding a baby bird, rather than on treating new mothers like adults: educating them about breastfeeding, letting them know that support is available, and then trusting them to make their own choice. And then honoring that choice.” But see this is where I don’t get it. How does the status quo honor people’s choices? We DO have breastfeeding moms getting the runaround and staff disrespecting them. This policy is meant to address that. In the meantime, everyone still gets what they want. This obsession about the locking up is still so puzzling to me. No mother could ever go and help herself to the formula cabinet. She always had to call the nurse to get formula brought to her. The lock is for the STAFF. And actually, feeding a baby human IS like feeding a baby bird (except for the worms part). They only need very small amounts. And they are OK if you bring them one meal at a time; they don’t know or care where the next meal is stored.

Finally, I am ALL FOR maternity leave. This is a HUGE and important component of breastfeeding support. And you better believe breastfeeding advocates know it and talk about it A LOT. It doesn’t mean that the hospital isn’t important too, and is a place where public health officials can actually make a concrete, immediate difference. People who are sabotaged in the hospital don’t ever make it to 2-3 months out as it is. I did some number-crunching for a WIC office and 50% of their moms who initiated breastfeeding stopped in the first two weeks. There is a huge drop-off after the much-vaunted 90% initiation, and that actually starts in the hospital for many people.

In response to continued upset about the locked formula: 

@Lauren: “That’s a staff education issue, not a mother education issue. It’s not resolvable by locking up baby food.” Again, locking up the formula is PART of what they are doing for staff. When you call for a bottle, do you know if the nurse has to deal with a lock or not? Nope. But she can’t be snagging bottles left and right for moms who don’t want them. Staff education is also part of that; it’s still just so puzzling to me that people are acting like the baby itself will have to open a bank vault to get fed.

Now this evening an update to the original post: 

*Update 8/1, 6:30 p.m. According to Samantha Levine, deputy press secretary in Mayor Bloomberg’s office, the information on the Latch On NYC site was wrong, and hospitals will not be expected to keep formula locked away (although they’re free to do so). She says they’re correcting the FAQs to reflect that. It seems like a rather a strange thing to get so diametrically incorrect, but removing the lock-and-key element of the Latch On NYC initiative does help things immeasurably.


 ??? I do not get it. This is what our scary locked formula storage looks like. It's in the nursery.
You type your login, hit a few buttons, and open the door. FYI, the breast pump kits, nipple shields, etc. are in this too. It helps the people who restock track the par levels so they can keep any supplies from running out. No one is upset that because those things are locked up, they're discouraging breastfeeding.

Can anyone help me understand all the drama over the locked cabinet requirement, which once removed has "helped things immeasurably"? I'd say out of all the things commenters were concerned about (shaming, lecturing) it is the least relevant. Ask any of our patients who use formula whether we keep it behind a lock (besides the lock on the nursery door) and I guarantee not a single one will know. Is it just some kind of gut feeling?


Anonymous said...

I am breast feeding and supplementing, which is working very well for me and my 3 month old. My concern about the push to not give free samples of formula is for those families that are actually in need. I was given free samples of 3 brands, of course I only supplement with one, but the samples I was given saved me quite a bit.
I think samples should be offered to mothers, that way no one feels pressured to take or to have to ask if they really need it.
On the issue of formula companies giving the samples to hospitals to distribute, duh, they're a company, they have to "advertise".

LaLaNeal said...

Thank you for clarifying a lot of misconceptions. I think many are off-put by the stories that say formula won't be gifted, anymore and just the way the news was broken. It insinuated that mothers were the target and not the staff, as you mentioned. I am SO glad to hear that nurses will be better educated. I hope they pass that knowledge on to every mother that passes through their doors. I know if I had the benefit of what o now know, BF would have been successful with my first child. It saddens me that I missed out with him.

Erica Plowman said...

I think this is a great explaination. I wish we had a breastfeeding itiative here in Maine. I expirenced nurses sneaking formula to both of my babies. It happens most a shift change. Nurses also arent educated in breastfeeding. We have 1 less than part time LC at our hospital. Just about everyone leaveswith formula because they didnt get the right help and gave up.

Becky said...

I think part of the problem is that in the FAQs it was not clear that these only applied to mothers who chose to breastfeed. The initiative stated that with each and every requested bottle the mother would be "educated." It didn't state outright that this only applied to mothers with a stated intention of breastfeeding. Again, with the lock and key -- it was not clear that mothers who chose to formula feed would have ongoing access to a supply of nursettes, as they do now. It sounded, according to the FAQs, like they would have to request each and every bottle every time their baby was hungry. This is how the Baby Friendly Initiative functions in some other countries, like New Zealand. Reports I've heard from mothers in those countries also say that the mothers aren't allowed to bottle feed in common areas of the hospital, like parents' lounges. They don't supply nursettes, mothers have to go to a locked room to sterilize their bottles, get cooled boiled water and prepare their baby's bottle for each and every feed. Each formula feeding mother has to be "educated" and sign a waiver allowing her to feed formula. I hear plenty of stories of bullying from women in these countries -- even from LCs that work outside the hospital and are still shocked by the stories they are hearing.

About the waiting -- there is certainly going to be more waiting than if the mother has the formula in her room! While an hour may be overreaching, on a busy maternity ward there may not be a nurse instantly available to bring a bottle. On the other hand, if this really doesn't apply to formula fed babies (and can you please point to a statement on this one way or another?) then this probably isn't important.

Danie Tips said...

Love this post! I was just wondering what state you work in?

Becky said...

Please read this personal account, which I believe is from NZ.

This is what people are imagining this initiative does. If this is NOT the case, then the language needs to be seriously clarified.

Anonymous said...

Great explanation! Personally, as a dedicated breast-feeding mama, I think it's a PR issue. It just sounds draconian to some people, i.e., "they are keeping food from my baby!" I assume most patients in a hospital don't really know how it operates so they can't imagine any reason -- like par levels -- for formula to be in a storage cabinet. Before this new rule, it's not like they were plopping a week's supply of pre-filled bottles in your room after you give birth saying "have at it."

Rae said...

Re: Why are people getting upset about the concept of formula being locked:
I believe that it's because here in the USA, the Land Of Opportunity, Freedom, where we have the Right To Do Whatever We Want, people don't like the idea of not having easy access to whatever it is they desire.

I wonder how many people know that when it was first developed, formula was only available by prescription from a doctor. Then the formula companies realized they could make more money if they took out the middle-man (hospitals) and sold directly to the consumer.

So comparatively, you would think people would be glad that it's still available unregulated for sale!

Serena said...

A friend of mine just sent 3 weeks trying to get her baby back to breast after the hospital tricked her (teen mom who hadn't done the research) into supplementing in the hospital.
I am all for this!!

Rebecca said...

@Anonymous: When you think about it, the reason the samples save you money is that the cost of giving millions of free samples - including samples that might go to mothers who do end up primarily breastfeeding and throw them in the trash - makes the formula you actually purchase cost much more. Noting is actually "free". Drug companies also used to give samples to medical professionals in order to advertise. Hospitals and physicians are now banned from giving drug samples in part because of this problem, and also giving the impression that they were participating in drug company marketing by endorsing one company over another. Now if you want, you can call most drug companies to talk about getting some free/subsidized supplies of their products. Formula companies usually seem equally happy to send samples if you call. I'm not sure why anyone would have so much trouble asking if they truly have need. Offering samples to mothers who don't plan to use them gives the impression that the hospital thinks they will need them, which can undermine a mother's confidence.

Rebecca said...

@Becky: "Again, with the lock and key -- it was not clear that mothers who chose to formula feed would have ongoing access to a supply of nursettes, as they do now." But my point is that they don't! At many hospitals you have to call to get the next bottle regardless of where it's stored.
The story from NZ sounds like an example of very poor patient care.

It is awful that someone would expect a 12-hour post c-section mom to do anything but rest and recover. Along with policies like Latch On's, staff need education on how to work professionally and sensitively with moms who are using formula. But to me, nothing about this policy says "Be a huge jerk to formula feeding moms, force them to prepare their own formula" (which BTW will probably never happen in the US for liability reasons if nothing else) "shame them continuously and forbid them from bottle feeding in public." It says "Make sure mothers are educated and have signed a consent, bring them appropriate amounts of formula, don't give formula to BF babies without a medical reason, document if there is some other reason."

"About the waiting -- there is certainly going to be more waiting than if the mother has the formula in her room! While an hour may be overreaching, on a busy maternity ward there may not be a nurse instantly available to bring a bottle." It might take a few extra minutes ,but nobody is stopping moms from calling before the baby is hungry. If the baby wakes up suddenly fussy, it shouldn't take longer than it does to prepare a bottle at home. If it helps to know, we also offer donor milk if parents need to supplement for medical reasons, and it takes much longer to get the donor milk because it's refrigerated and has to be warmed before every feeding.

"On the other hand, if this really doesn't apply to formula fed babies (and can you please point to a statement on this one way or another?) then this probably isn't important."
It looks like after all the lock-and-key drama they've taken down the FAQ, so there doesn't seem to be much to work with. All I can tell you is that this is how it works at our hospital, and it sounds like the individual hospitals will have flexibility.

Orlando Orthopedic said...

Thanks for clarity. Great post:)

Becky said...

I'm assuming the formula access varies by hospital, many formula feeding moms I've spoken to were given a small box of the little nursettes and individual disposable sterilized nipples to keep in their room with them. I don't know, I've always breastfed and never even encountered formula in the hospital at all.

I'm assuming the FAQs will be back up at some point and will hope for some clarification. Thank you for sharing your perspective on how this would work in real life.

Khyraen said...

if you change "foaming at the mouth" to "angry" can my comment be posted. I'm going on much too little sleep to self regulate very well. (2nd to last para in very long comment) thanks, and sorry about the former being rude.

Khyraen said...

his has to be the most frustrating debate in the whole bfing education arena. When you get a bunch of moms and columnists acting like their babies are going to be starved just because hospitals are being required to provide informed consent, stop marketing for formula companies, and keep better records of infant feeds, you really can't have a rational discussion of facts at all.

Where are the ppl up in arms because I have to ask for and wait, sometimes hours, sometimes more than a day, for help in getting my baby latched on so she can eat? The LC where I delivered is only available Mon through Fri business hours and sometimes she is in a meeting, and anyway, there are only 2 for the whole hospital. Can you imagine if they were only providing bottle of formula during business hours (but they aren't, are they?)

Where are the ppl up in arms that I cannot have breast feeding supplies provided for free such as creams and nipple shields? When my nipple shield fell on the floor of the NICU in the middle of the night before she had fed, I was told it was my responsibility to provide for another despite the fact that it was time for her feed, whereas bottle feeding babies get new bottles and nipples with each feed--and if they are dropped, they simply get another. Can you imagine if they told you that if you dropped the bottle on the dirty floor you had to go out and purchase a new one (but that's never happened, has it?)

Why aren't there articles bemoaning the fact that hospitals don't have to provide breast pumps for nursing moms whose babies are still in the NICU? My baby was born at 29 wks and I was released 3 days later, the eve before a holiday weekend which would last 5 days, and given a location 70 miles away that would be open for a few more hours where I could rent a pump--and I live in a big city. Can you imagine a mom formula feeding her NICU baby being told that if she wishes for him to continue to be fed formula, she's on her own to figure out how to get that for him in the next 2 or 3 hours from 70 miles away (but that's never going to be permitted--the formula is right there in the hospital for any mom who wants her baby fed it.)

Where are the feminists screaming about choice when my bfing choice is undermined? When my baby is given a bottle of formula without my consent? When my NICU baby was switched from human milk fortifier to formula to fortify without even asking me?

When it comes to formula, we are expected to give a wide berth. Never mind that bfing is healthier for mom, babe, and the environment and would save everyone tons of money, formula is the preferred method of feeding in the US and any attempt to encroach on its advantage is met with shrill cries from self-guilting bottle feeding moms and angry feminists who see any effort to educate about the benefits of breast feeding or improve bfing rates as an attempt to enslave the entire female gender.

You might have to wait a few minutes for a bottle? Guess what? When my baby won't latch, I have to wait way more than a few minutes for help which might be good or might be some idiot nurse who offers a bottle as a solution or worse. So stop complaining and, if your worst fears come true--which they won't--then welcome to the breast feeding mom's world. Now maybe we can all work together to improve the management of maternal and infant care in America.

Knitted_in_the_Womb said...

I agree with Becky about the issue with women who choose to exclusively formula feed. I've exclusively breast fed all of my children, but I do think the rights of formula feeding mothers should be respected. I don't think they should be forced to request EVERY bottle...the need for bottles should be anticipated so that bottles can be delivered before the baby is showing signs of hunger.

Also, the issue about over-feeding a newborn...I've never seen a bottle smaller than 2 oz dispensed in the hospital. Perhaps it happens in the NICU...but 2 oz bottles do seem to be standard size.

Regarding the comment from "Anonymous" On the issue of formula companies giving the samples to hospitals to distribute, duh, they're a company, they have to "advertise".

Certainly...yes, formula companies can "advertise." But until the hospital cafeteria starts routinely serving food to patients with all the brand name labels still intact so that patients know what kind of green beans or fruit salad they should purchase...I think that labeled formula samples should likewise not be used.

Anonymous said...

I agree with you 110%. I had no problems with my first baby, other than an overly helpful nursing staff who actually tried to help when we were nursing just fine. They didn't like that I held my breast in the "cigarette hold" and they didn't like that I wasn't mashing him into my boob every time I latched him on. But they were enthusiastic, so I easily forgave them for trying to fix something that wasn't broke. They looked at me and saw a very young single mom who surely needed all the help she could get. Me, I was 22, though I did look like I was about 16, and my mom and aunts breastfed my younger siblings and cousins, it came naturally to me. But with my 2nd child, it was another story. I had a very hard labor, and ended up having in epidural (I had a natural birth with my first and subsequent babes) that didn't work on one half of my body, and worked too well on the other. I couldn't walk for 4 hours after birth, and every time I called a nurse to bring me my baby, I was told he was still in observation in the nursery. They ended up giving him a bottle of formula, getting my husband (his first baby) to agree to it by telling him the baby's sugar was dangerously low and that since my epidural hadn't worn off, I wasn't allowed to breastfeed. Total lies! He was with the baby, and hadn't even known I had been badgering the nurses to bring him to me. When I called the nurse on it, she told me, "There's no way you could make enough milk for a baby that big." He was 9lbs 4oz at birth, yes, but guess what? He was 24lbs by 4 months and still exclusively breastfed! The ignorance is astounding! When the full-time real lactation consultant arrived, whe knew without asking exactly which nurse had done it, and after helping me get him latched on (he had some serious nursing problems the first few weeks!) she said she could hear him swallowing, so my milk was obviously already coming in, that bottle was soooo not necessary!

bethday said...

I didn't send you this one because I didn't find it interesting or thought-provoking, just over-the-top catastrophizing. Considering how sensationalized the article was, I'm amazed you had the fortitude to dive into the comments. We've gone back and forth on the issue of bfing and feminism, but even I found this article well into scare-mongering territory.

Ghengis Mom said...

Yes! Oh thank you for this article.

micaela said...

this was an excellent post, thank you! I don't understand the constant negativity over breastfeeding-promotion efforts, even from people who say they think it's great. I'm not a regular on here so, have you written about the regular accusation I've seen on sites like Feministe that LCs are "lactation bullies"? Because if you haven't, maybe that would be an awesome follow-up post to this.

I relate a lot to what Khyraen wrote as my firstborn was born prematurely & was in the NICU for a week. When people say breastfeeding is a choice, they seem to have no understanding of how often that choice is undermined by events and people that aren't under the mother's control at all. When I look back at all I had to overcome to breastfeed my first baby, I'm amazed I made it at all.

Rebecca said...

@Khyraen: I love your comment! All so true. I have been wanting to write a post recently about what I think it takes for a hospital to be truly supportive of BF moms and a lot of what I have thought about, you have written.

Rebecca said...

@Micaela: I've definitely seen accusations like that around the internet, but not specifically on Feministe - if you have links, I'd love to see them.

@Anonymous 3:10pm: Isn't it interesting how people are told they need formula because the baby is "too big", and others that they need to give extra formula because the baby is "too small"? What size baby is "just right"??

Rebecca said...

@bethday: But the catastrophizing is what sends this into crazyville, and tells a generation of women who identify as feminists that breastfeeding is not feminist and infant feeding is "all about choice" (where have we heard that rhetoric before?)

Anonymous said...

love your post! as an OB nurse, I wish the formula was locked and we had a consent for bottles.As a night shift nurse I see women break down. "Let me take your baby to the nursery so you can sleep" is so common. makes me crazy! I never suggest taking your baby. I don't offer formula. I help moms breast feed.And again, I don't really care how your feed your baby, but if it's your first, I encouragage.Because a new mom has no idea. And it's so depressing to come back the next night and find them with bottles...defeated by the bottle again.

Erin said...

I think maybe if there are people so concerned that this "locked up" formula is going to be impossible for them to get and their baby will starve, then maybe they should just plan ahead and bring their own formula to the hospital. After all, they bring the baby's going-home outfit, his car seat, etc... why not bring his food too if they want to formula feed? Aren't moms billed for the formula they use in the hospital? Or is it donated by formula companies and therefore paid for by consumers in the increased cost of that brand of formula in the stores?

I am glad to see this happening. If we present breastfeeding as the norm and formula as an extra you have to ask for, then hopefully more hospital staff will begin to truly see and present breastfeeding as the norm.

I do think the tea party comment was a bit off-puttish... I don't identify with them, but I am conservative and have many issues with "Obamacare," yet I still can totally get behind the baby-friendly initiatives. Some of us breastfeeding supporters are conservative too, so don't leave us out. ;)

micaela said...

@Rebecca - I'll be honest and tell you that for my own mental health, I've finally learned to avoid sites like Feministe, Jezebel, or anything written on the subject of breastfeeding or birth/parenting by Hannah Rosin, Jessica Valenti, or Amanda Marcotte (as well as a few other prominent feminists). Last year there was that dustup between Valenti and Gina/TheFeministBreeder precisely over the topic of BFHI being implemented in England and here in the US and there were plenty of references made to "boob nazis" and "lactation bullies" all over supposedly feminist/repro choice websites. Most recently, a couple of days ago I unfollowed a blogger for using the bullies term on a post she wrote for the LifetimeMoms site regarding Bloomberg's new policy. These people give me migraines... and flashbacks to all my struggles trying to get breastfeeding established, maintaining it after I went back to work, and later relactating at 4mo post-partum after a bout of dengue fever that landed me in the hospital for a week. All the while being asked "why don't you just give him some formula?" Too many of the women I've spoken to who have negative feelings about breastfeeding never received the support they needed from their medical care providers! As long as doctors and nurses (and MILs, bosses, friends, and society at large) default to "just give the baby a bottle of formula" whenever there's a problem, breastfeeding rates at 3mo & 6mo post-partum will be less than optimal.

And it goes without saying that having access to family leave would help enormously, but it starts with the first few feedings, the first few days and weeks, and that underlying message that if things aren't perfect giving a bottle of formula will somehow work like magic.

(and now I'm adding you to the list of bloggers I follow)

Anonymous said...

Can you explain more about what mothers have to sign and what the policy will be in NYC? Is it all mothers that ask for formula, those that ask for personal reasons, those that need it for medical reasons..?

lorien_i said...

This is a great post! Very informative!

@Khyraen, you are spot on.

I would add to the discussion that in order to be truly 'Baby Friendly', hospitals are going to have to work much harder on being 'Mother Friendly' and birth friendly in particular. Crappy birth experiences too often lead to crappy breastfeeding experiences, something totally ignored by hospital administrators.

Parenting Patch said...

"I am breast feeding and supplementing, which is working very well for me and my 3 month old. My concern about the push to not give free samples of formula is for those families that are actually in need. I was given free samples of 3 brands, of course I only supplement with one, but the samples I was given saved me quite a bit.
I think samples should be offered to mothers, that way no one feels pressured to take or to have to ask if they really need it.
On the issue of formula companies giving the samples to hospitals to distribute, duh, they're a company, they have to "advertise"."

Why do you feel that you or any other parent is entitled to any free samples. All babies need diapers (for the most part), but you don't see me getting upset that I am not getting any free diaper samples. Yes, formula can be expensive, but mothers do have another option: breastfeeding. I need to eat to be able to produce breast milk, but I don't go around asking for free food samples to make sure that I eat enough. If you want to formula feed, fine, but people need to stop thinking that they are entitled to free samples.

HeliconiaPink said...

I am a doctor. We don't promote ANY companies in my hospital, formula or otherwise. Why? Because I am a doctor, not a paid advertisement. Sure they need to advertise. The formula companies have a plethora of opportunities to do so - TV, radio, billboards, mailings, emails, web ads etc. My hospital is not an outlet for advertising ANY product...

HeliconiaPink said...

AMEN!!!! (As a neonatologist, I apologize for the appalling experience you had in the NICU...)

Anonymous said...

I have been an OB nurse for the past 30 years and have 3 children of my own, who were all breastfed initially, but now, wished I could have breastfed even longer than I actually did. This is something that I unfortunately cannot go back and redo.. I have seen first hand that by giving the "free" formula diaper bag to breastfeeding moms and add to that, decreased knowledge of hospital staff, including nurses and doctors, and the lack of support of society in general, contribute to the decreased success rates for breastfeeding mothers once they are discharged from hospital. It wasn't until I decided, as an OB nurse, to increase my knowledge about breastfeeding and become a lactation consultant myself, when I finally realized what was obviously going wrong in our hospital setting as I knew it. For breastfeeding mothers receiving the so-called "free" formula samples in your diaper bag, please understand that it is a 100% marketing tool. If your breastfed baby "needs" the formula after you are discharged either by choice or by need, then go buy it. It's that simple and not hard to locate. The good news is that more and more professionals working in the "baby business" are becoming more and more educated and supportive. With this knowledge and support, will hopefully bring higher success rates once mom and baby leave the hospital. I am so thankful for the hard working advocates out there, working on a daily basis, to help build the network of support for mother's choosing to breastfeed. I am seeing more and more lactation consultants staffed in hospital settings, in pediatricians offices, private practices. I am seeing great WIC support for breastfeeding mothers. I am seeing (just recently), a law being passed, that insurance companies will be providing coverage for the needed breast pumps for mothers choosing to go back to work. Although we have a long way to go, I have seen great changes in the past 5 years for the better. So to complain about locking up "supplies" on a nursing unit is ridiculous! Let's move beyond the pettiness and let our country be the "showcase" around the world, raising healthier, smarter babies which has been scientifically proven. Babies were born to be breastfed, however for some, either by choice or for those overcoming challenges and may not be able to breastfeed, our society should not feel guilty about promoting and supporting what is BEST for our babies.

Anonymous said...

You can still request free samples directly from the formula companies prior to giving birth (or after for that matter).

Rebecca said...

@anonymous: They have taken down the original FAQ on the policy so I don't know if there was more information there, but what's left is pretty broad policy, nothing specific. I imagine it will be up to each hospital to set their personal policy. Ours is a simple one page form, signed by any mother who wants to supplement for personal reasons. Mothers who plan to exclusively formula feed from delivery do not need to sign it.

Anonymous said...

When was the last time you were in the hospital? From personal experience with more than one hospital, I can tell you that it can easily take a half and hour or more to get a Tylenol, so telling me that getting formula is pretty much the same as getting tylenol IS scary. When a proponent of the policy explicitly states that the key to getting women to nurse is to make formula "less accessible" and that they *want* to make it difficult for a nurse to get a bottle of formula for a mother, that is scary, too.

Rebecca said...

@Heliconia - Thank you for working in an ethical environment!

@Anonymous 11:42am: I work in a hospital, so I am there multiple times a week. I did not say that getting the formula is like getting Tylenol - I just said they are both locked up the same way. As I have stated multiple times, making formula "less accessible" and making it "more difficult" to get is for the STAFF who want to throw around unnecessary supplements, not for the MOTHERS. Once again, no one waits half an hour for a bottle in our hospital. I would be surprised even they even waited five minutes. If even the possibility of waiting for a bottle is scary, I suggest mothers request the next bottle well before they think the baby will wake up. Or if the baby wakes up unexpectedly, since these are BF mothers as well, they can BF the baby while waiting for the bottle.

Sarah said...

Really? People are complaining about having to wait for a bottle? That's nothing. My son latched on right away (in the recovery room, I had a C-section). Then his bili levels went up and the dr told the nurses I "had to" supplement. Crying, I tried to give him a bottle and he refused (he knew what was what). The nurse then SHOVED a bottle in my son's mouth, causing him to shriek and choke. Once he choked and spit the formula right at her, she gave up and let us be. Well, guess what? His bili levels went down just fine with frequent breastfeeding. When I had my second child (also via C-section, I was denied a VBAC), they refused my requests to see and feed my child for well over a half hour. My husband had to go in more than three times before they finally relented and brought her in. She was perfectly fine and healthy at birth so there was really no excuse. If she had been my first, I might not have been so persistent. Then she, too, was diagnosed with jaundice and was put under the bili lights (which was not my choice). I was only allowed to breast feed her every THREE hours, despite KNOWING that she wanted to feed much more frequently, especially during the day. When I was engorged, I requested to see my own baby and I was told I had to wait 45 mins or AN HOUR before they could take her out from the lights. At one point, I walked in to see my baby and saw her crying under the lights only to have a paci shoved in her mouth. I was horrified and demanded to be able to feed her and hold her. They said she needed to be under the lights. Bullshit. Her levels were lower than my sons and his levels went down without any intervention. At one point, I was in tears due to the pain of being engorged and being at hour two without being able to feed. I went in to get my baby (and yes, I had to walk down to the nursery MYSELF b/c they wouldn't bring her to me, this day two after a C-section) and they wouldn't let me have her even though she was awake and I needed to feed. They suggested I "pump and they could give it to her in the incubator while she was under the lights". Um, no. I'm not pumping so you can give my perfectly latching, two day old baby a bottle while she is not being held or cuddled. I truly believe she didn't need the lights at all. She needs to be held and loved by her mother and frequently fed so she can get those levels down. I told them in no uncertain terms that either they could get her out or I was going to get her out myself. This is MY baby and I AM going to feed her. They relented. Once again, her levels went down after a few days and she was totally fine. Jaundice is very common and I do NOT for the life of me understand why the hospital (St. B's) acts like supplementation and intervention are always the answer. I know that malpractice insurance is very expensive in our state (NJ), but its completely unacceptable to treat mothers this way. Anyway, yeah, there is a lot of lip service paid to breastfeeding promotion at St. Barnabas, but actions speak louder than words.

Katie Moore said...


I just had a quick question in regards to your website. If you could email me at your convenience that would be great!



Rachel said...

I can see why some women feel threatened by this, but if they want to feed their baby formula, bring some:)

I used to work postpartum, nurses do give it without asking the mother. Given the fact that it does have negative consequences, it should be treated like a medication, imo.

Lea@Doula Training said...

I've got some good things learned from here.
I just wished that most nations now are encouraging breast feeding!

Anonymous said...

I am also an IBCLC in a Baby Friendly Hospital and a trained NICU nurse. Nice post. Dead on about the education and informed choice of the parents. BFHI isn't about forcing people to breastfeed. It's about educating about the benefits of breastfeeding and supporting parents who choose to do so. It is about adopting evidenced based practices that facilitate good public health outcomes. It's about not allowing formula companies to market in the hospital setting to a vulnerable population. For the record I was asking my prenatal breastfeeding classes how many had already rec'd formula samples or coupons unsolicited in the mail...100% had. So no need to use health care professional to market products. As for the storage of formula? It's always been kept in a locked stockroom of some kind. It must be checked by central supply to make sure it's not expired etc.

Cory Ellen said...

I know I'm super late to this, but thank you for saying everything I wanted to during the original round of this discussion. I'm so glad I found your blog!