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.

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 ??? 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?

The breastfeeding police, or how what you don't know can hurt breastfeeding mothers

Anne at Dou-la-la has a guest post up on The Leaky Boob and it is a gem. Here's a few excerpts:

YES, I do think that women who feel they ‘can’t’ produce enough milk have often been sabotaged (i.e. booby-trapped) in ways they are unaware of. And one of the things that most often thwarts them is misinformation.
HOWEVER. Statements that imply that really, everyone can breastfeed and if they didn’t succeed, they just didn’t try hard enough, mind over matter? EVERY BIT as misinformed as the bad advice that might have led a mom to undermine her supply or her belief in her supply. I know it’s highly unorthodox for a breastfeeding advocate to call other breastfeeding advocates out when their intentions really were good, but I see so much poor advice online that it’s really starting to get to me. ...


This does NOT mean that there is not a place for peer support. There so absolutely is is – La Leche League turned the tide on breastfeeding half a century ago and its very foundation was peer support. But part of being a trustworthy resource is knowing when something is beyond your knowledge – even for professionals, certain things are beyond one’s scope of practice, and it is crucial to have the honesty and humility to know when to refer.

I am a brand spankin' new IBCLC (just got my exam pass in October 2010). Before that I was trained as a breastfeeding educator (think peer counselor-type level) and as a doula, and I wrote my senior thesis on breastfeeding. I knew a fair amount about this whole feeding-babies-with-your-breast thing, I really did. But once I started training as an IBCLC, I suddenly realized how much I DIDN'T know...and when I started actually working as an IBCLC, I realized how much I STILL didn't know all OVER again. In fact, the more I learn the more I stop answering questions confidently, and instead turn to my mentor LCs (with their 5-20+ years of experience) and reference books to double- and triple-check what I THOUGHT I knew, before I give any answers. And in the meantime I hear loads of unhelpful or clueless "advice" being doled out left and right. (If I hear one more NICU nurse suggest "drinking lots of water" as a solution for low supply...)

As Anne says, this isn't a "leave it to the experts, ladies" kind of situation - there absolutely is a setting for educated, compassionate peer support and it it SO important. But let's have it be educated and compassionate - not rife with statements like "everyone can make enough milk" (I saw 2 women in the hospital this past week with classic signs of insufficient glandular tissue, and if they don't reach a full supply even with optimal milk removal, there will be a pretty darn good physiological reason that they CAN'T).

When they hear that I'm a lactation consultant a lot of people share their difficulties with breastfeeding with me (same goes for doula and birth!) I sometimes hear it as a defensive explanation, sometimes as a way of continuing to grieve/process the experience, sometimes as a simple "oh, you'll be interested in this" conversational topic. No matter what, it's hard to find a way to respond, but even when I hear something in their story that doesn't sound accurate or misguided, I try to focus on what I can simply validate and acknowledge. "Exclusively pumping is so hard, I'm impressed you stuck with it as long as you did", or "That sounds so painful, I'm sorry that happened to you". (One of my LC colleagues says, "I'm sorry things didn't work out; often people find breastfeeding is easier with the next baby" to help leave the door open for trying again in the future.)

What I don't do is ask questions or try to learn more about the situation. If a mother thinks things could have gone differently or wants to know how to change things with the next baby, she will ask me! In the meantime, support, empower, offer resources to help the mother learn more and get more advanced help - but let's stop assuming we know everything about a woman's situation, particularly after the fact. It doesn't do her any favors and it sets breastfeeding back as well.

Please read Anne's post for a thought-provoking discussion on this topic! And please share your thoughts - what do you say when a mother shares her difficult breastfeeding story? If you had challenges breastfeeding, what were helpful/unhelpful things that people said to you?