Which part of baby-friendly do you have a problem with?

So since I wrote my screed, more has happened (all forwarded to me by the endlessly helpful Beth!) At the end of my last post, I linked to a post by Gina at Feminist Breeder called "Why I am a Feminist AND a Lactivist", responding to Jessica and talking about why she supports Baby-friendly. Apparently some Twitter activity around the past happened (I try to stay off Twitter - I'm already addicted to the Internet enough as it is!) Then Jessica Valenti wrote a response to the tweets (hard to tell if she actually read Gina's post). Jessica said:

I’m sympathetic to Catilin’s argument that there are problems with the way that formula companies market their products (there’s quite a long history there). That said, of course free formula in hospitals is done from a marketing perspective, not for the good of women. Companies are companies and they’re targeting their audience. But I’ll tell you what - when my breastmilk ran out while Layla was in the NICU, I was sure as shit glad there was formula there to feed her. ...

But the marketing/corporate aspect was not really what Hearts’ post and my response was about - we were addressing the hypocrisy of judging women who choose to formula feed and the way they are made to justify their choice. In this case, the fact that the hospital would make formula available to women who “medically” needed it - what constitutes medical need? And what if women simply didn’t want to breastfeed? Isn’t that her right, and shouldn’t she be equally supported for that decision in the same way a breastfeeding mom is?

Except, you know, that wasn't what Jessica's original post was about. Maybe that's what she THINKS it was about, because it triggered feelings around formula feeding, breastfeeding, guilt, shame, expectations, etc. But her original post was about Baby-friendly, and criticizing hospitals for "denying" women the opportunity to use formula. Gina was pointing out that she was incorrect; Baby-friendly is about denying formula companies the opportunity to use hospitals for marketing purposes, and getting hospitals to adopt best practices to support breastfeeding.

But Jessica also covers that in her second post (which is confusing because she also said in the second post that's not what the debate was about), and says she thinks limiting formula marketing is paternalistic:

... the argument that women are “vulnerable” to free formula is just plain insulting to women’s intelligence. I trust women to make their own decisions.

As Gina points out, that's not the case for a lot of other marketing efforts that feminists take issue with:

Feminists are constantly calling out “Pregnancy Crisis Centers” for being predatory. They snag women who may be alone, scared, and confused by a major reproductive choice, and they offer them freebies to gain their trust. They tell them they’re helping them make a decision about parenting, but what they’re really doing is piling their Anti-Choice agenda on them, promising the mothers they’ll help, and then vanishing when it comes time to foot the costs of raising this baby. Feminists recognize that these centers are preying on a woman during a vulnerable time in her life. We’re not saying these women are stupid or that they’re being duped. We’re not saying that one choice is better than the other. We’re saying that the marketing is absolutely unethical.

Feminists are constantly calling out and boycotting the beauty industry for shaming women about their bodies, their lifestyles, and their choices. Why do we do that IF we think women are immune to marketing influence? Isn’t a woman smart enough not to fall for that “skinny is better” imagery? Don’t we trust her to recognize the airbrushing for what it is?

I am very curious to see how (and if) Jessica responds to that argument. But in the meantime, let's move on to her conclusion:

Listen, I support breastfeeding women - long before I had my daughter I was blogging about the heinous lack of resources for breastfeeding mothers and the various ways they are discriminated against. I think we need mandated paid maternity leave, insurance that pays for lactation consultants and breast pumps, employers who are required to have a space and breaks for pumping moms, hospital- and state-funded breastfeeding support groups and more. But I also believe that formula feeding your child is just as valid and healthy a choice as breastfeeding - it’s not something women should have to justify or be denied resources for or access to.

I agree with her! Breastfeeding women deserve time, space, resources, and support? yes! Formula feeding as valid a choice as breastfeeding? Yes! As healthy or even MORE healthy than breastfeeding? Yes, sometimes! Should you have to justify it to anyone else? No! Should you be denied resources for formula feeding? No! Wow, look, me and Jessica agreeing on everything. Except the part where she slams me, the organizations I work with, and the work that we do. Because she still thinks Baby-friendly can "suck her left one". I wrote in my last post that she doesn't seem to actually understand what Baby-friendly is. But maybe it didn't get through. So here's a little review for Jessica Valenti and anyone else who's confused:

Here are the Ten Steps to Baby-Friendly, from the UNICEF Baby-Friendly page.

1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within one hour of birth.
5. Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6. Give newborn infants no food or drink other than breastmilk, unless medically indicated.
7. Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no pacifiers or artificial nipples to breastfeeding infants.
10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

The Ten Steps prevent hospitals from doing things like routinely supplementing breastfed babies, not training their staff, routinely separating new babies from their mothers, and trying to force babies to feed on a schedule. Good stuff, right? So where is the issue here?

The current debate seems to center around Step 6, Give newborn infants no food or drink other than breastmilk, unless medically indicated. This is an international guideline, and in the U.S. Step 6 has been reworded as "Give breastfeed newborns no food or drink other than breastmilk, unless medically indicated." As the U.S. has a long history of formula marketing via hospital, Baby-Friendly USA has added this clarification to Step 6:

The Baby-Friendly Hospital Initiative supports the International Code on the Marketing of Breast-milk Substitutes ("WHO Code"). The WHO Code stipulates that health care facilities and professionals neither accept nor offer free or low-cost substitutes for human milk. In keeping with the Code, the Baby-Friendly Hospital Initiative asks facilities to purchase all infant formula in the same manner as it purchases all other supplies. Additionally, facilities should not give infant formula samples, literature, or other items bearing the name of an infant formula product to breastfeeding mothers.

Since the original story was about a UK hospital, I looked up the UK guidelines and found their page on Step 6. They have not reworded the guideline from the international version; they have set out the following criteria for following it:

No food or drink other than breastmilk should be given to breastfed babies unless:
- there is an acceptable clinical reason, the baby is unable to breastfeed and there is no/insufficient breastmilk available
- the mother has made a fully informed choice to feed her baby other than from the breast.

No promotion for infant food or drink other than breastmilk should be displayed or distributed to mothers or staff in the facility.

The hospital in the article that sparked all this seems to have drawn ire for asking mothers to bring in their own formula if they decide to formula feed without a clinical/medical reason. But that requirement is not part of Baby-friendly. It's not required in the international guideline, or in the U.S. interpretation, nor in the U.K. interpretation. This hospital has chosen to make this change part of going Baby-friendly, but it is not required. I said in my original post that I thought that whether was a good idea or not was a legitimate subject of debate, but it is not actually being made the subject of THIS debate. Instead I'm seeing people call Baby-friendly shaming and lump it together with the anti-formula douchery on Twitter and that's just plain wrong.

Saying, as Jessica Valenti did in her original post, that "refusing to give mothers access to formula is not “baby friendly” or helpful - it’s shaming and in some cases could be very dangerous" shows that she REALLY didn't understand what Baby-friendly was about, since apparently she never saw "unless medically indicated" in Step 6. No Baby-friendly hospital would put a baby in a "very dangerous" situation by denying them formula. "Medically indicated" is how we avoid "very dangerous". It really bothers me that someone would imply that LCs, nurses, and doctors and those hospitals would shrug and say "Sorry, no breastmilk no eat!"

I made this point before and I make it again now: Baby-friendly is not about you needing to justify your choice to formula feed to hospital staff. It is about the HOSPITAL having to justify its OWN reasons for supplementing breastfed babies. Yes, that hospital in the U.K. differentiates between medical and elective supplementation, and asks the elective supplementers to bring in their own formula, and that may seem judgy and we can talk about that. But let's talk about it WITHOUT bringing Baby-friendly into the mix and WITHOUT implying that health care professionals are starving babies.

I'm glad formula was there for Jessica's baby. I'm glad she likes formula feeding and that it was a healthy choice for her. I'm really sorry people are jerks about how women feed their babies. I just don't see the connection between all those things and Baby-friendly. As I said in my last post: they are different things. Jessica had the opportunity to say "Hey, I get what Baby-friendly is, I just have a problem with this part of it and let's talk about that", but instead off we go on the mommy-wars train to Stopjudgingmeville, complete with opportunities for self-proclaimed lactivists to show off their ugliest, judgiest sides. I get so depressed by how so many feminists hop on this train unquestioningly. Back to my conference proposal in an attempt to encourage more people to think about this in a more critical way...

Another screed on breastfeeding & guilt – this time with cussing!

Oh, this comes at a great time. This comes at a PERFECT time. I was literally in the middle of writing a conference proposal for a presentation on breastfeeding as a reproductive right, and I check my e-mail. My friend (thanks for loving Internet drama, Beth!) had forwarded me the following links on breastfeeding and baby-friendly:

The first was from a feminist blog called the F Word, by a guest blogger named Laurie Hearts, "Baby friendly - but is it woman friendly?":

Manchester's largest maternity unit, St Mary's, is set to become a Unicef-approved 'Baby Friendly' hospital by ceasing to provide free formula milk to the women who give birth there. ... Women who choose to formula feed at St Mary's will have to bring their own ready prepared milk in cartons from this November; powdered milk will be banned for health and safety reasons. ...

In an era when many feminists are (in my opinion rightly) dismayed by the suggestion that a woman's right to an abortion should be subject to conditions, I have been shocked by the high level of acceptance when it comes to the notion that women who formula feed should be forced to justify their choice, not only to medical staff, but to pro-breastfeeding women. While I have never seen anyone claim that formula is better than - or even equal to - breast milk, a large number of women are vociferously and uncompromisingly against a woman's right to choose formula milk. I have witnessed a sizeable number of women, some of whom are self-declared feminists, debating on one another's social media profiles and calling for formula to be made illegal.

The second was from Jessica Valenti's blog:

[F]or me, formula feeding was absolutely, 100% better than breastfeeding. Like, life changing better... refusing to give mothers access to formula is not "baby friendly or helpful - it’s shaming and in some cases could be very dangerous. Enough already.

I usually don’t swear very much on my blog (real life is a different story) but like all good screeds, this was written while I was feeling just a little riled up. So: Holy shit. Let’s just make this clear: baby-friendly is not about preventing you from formula feeding. I work in a hospital that is pursuing baby-friendly certification. Most women at our hospital plan to breastfeed. Some women plan to formula feed. A fairly significant percentage of the breastfeeders choose to use formula at some point. The straight-up formula feeders never hear a word about breastfeeding from us. You told us on admission you planned to formula feed, here are your bottles. The breastfeeders who need to use formula for medical reasons – and they are very clearly outlined, including hypoglycemia (low blood sugar) and excessive weight loss – get formula too (and we are very fortunate to be able to offer them the option of donor milk if they are not comfortable with formula.) The breastfeeders who ask to use formula – this happens not infrequently, often because “I think I don’t have enough milk” – get education and discussion, sign a consent form, and then are given formula too. (No, we don’t have them bring in their own formula like the hospital profiled; we can debate whether that’s any different from making them bring their own baby clothes, but I think there’s a legitimate debate there.)

However, while I have a lot of respect for Jessica Valenti, she and the other blogger are completely mischaracterizing the issue here. Baby-friendly is not part of the mommy wars, and I honestly think it is irresponsible to do so. What makes hospitals baby-friendly is not preventing women from choosing formula feeding, or refusing to give them formula when their babies need it. Baby-friendly is not about forcing mothers to do anything. Baby-friendly is about preventing HOSPITALS from shoving bottles and pacifiers into breastfed babies’ mouths and then sending their unknowing mothers home with a screaming, nipple-confused baby who won’t latch. Baby-friendly is about preventing HOSPITALS from accepting “free” formula and gift bags and samples from formula companies, turning the hospital into a shill for a for-profit company, and engaging in practices that research has shown make it less likely for women to reach their own breastfeeding goals. Baby-friendly is about forcing HOSPITALS to offer regular breastfeeding education to all their staff, including nurses and doctors, so they can help mothers and not give them crap advice. Baby-friendly is not about the mommy wars. It is not about trying to force any mother to breastfeed. It is about changing HOSPITAL practice, and whether or not you realize it, most hospitals in the U.S. have a long, long way to go. Baby-friendly is about offering evidence-based care to promote health.

“Who are you to decide that breastfeeding promotes health? Formula feeding can be lifesaving!” Hell yes it can. You think I don’t see that? I see that all the time. When women are dealing with a new baby, sleep deprivation, hormone shifts AND feeding issues, you are dealing with a potent cocktail for severe depression – you think I never meet women with serious PPD? You think I don’t see women with intense pain from feeding, or a history of low supply, or a baby who isn’t transferring milk well? You think I don’t see women who are BBAC (breastfeeding baby after challenges), who are having the same issues as their last hellish breastfeeding experience, where we talk through their situation and their emotions and their individual needs and they decide that on balance, formula feeding is the healthiest thing for them and their babies? You think I don’t see women with insufficient glandular tissue to make enough milk, whose babies will starve without supplementation? That I never meet women, like Jessica Valenti, who had life-threatening health issues and premature deliveries, who are pump dependent and struggle to make even a tiny supply? You think that because I work at a baby-friendly hospital I refuse to let any of those women use formula? Of COURSE I do. Of COURSE formula is lifesaving. And it doesn’t NEED to be lifesaving to be OK. I see women who just decide that breastfeeding isn’t for them. They don’t want to breastfeed. Maybe they said they wanted to because they wanted to give it a try, but they’re not that into it. I shrug and move on. As a lactation consultant and public health professional, I would love for more women to choose to breastfeed. The lady in Room 4 doesn’t want to? We gave her the spiel, and it’s her choice.

So “formula-should-be-illegal” Judgy McJudgersons out there (even though I think there are fewer of them out there than their reputation): Shut up. Yup, I said it. You can never know what’s really going on in a woman’s life. When you demand that a woman give you a good reason for not breastfeeding, you have no clue what you’re asking. How about this: “Well, I was sexually abused as a child and I had very frightening flashbacks every time I breastfed.” Is that the reason you need to hear? Women don’t need to justify their feeding choices to you. They don’t need formula to be made illegal “for their own protection”. Because even if a woman doesn’t have a “good”, “morally correct” reason to breastfeed (just like many women do not have “socially approved” reasons for having an abortion), “I just didn’t want to” is reason enough. “But if they were really informed – ” No. I know we don’t do a very good job with breastfeeding education in this country. Please, if you really care about educating women, do not do it by asking nosy questions of your pregnant friends or of the woman with a bottle next to you on a park bench, or post judgy comments on mommy wars-fueling news articles. Lobby our elected officials to stop slashing funding for maternal and child health programs. Volunteer to teach classes at a community center. Write a letter to your local hospitals encouraging them to become (gasp!) baby-friendly.

Finally, let’s stop with the idea that women who tried to breastfeed – who wanted to breastfeed – and couldn’t breastfeed, shouldn’t be sad. Do I think they should feel guilty? That they should feel ashamed? HELL NO. But it’s OK for them to mourn something they had hoped to do, and couldn’t. It’s also OK for them NOT to mourn it, to just accept it and go on, to appreciate the things about formula feeding that are positive for them. Everyone is different. But women who had looked forward to providing milk for their baby, who planned to have a positive nursing relationship with their baby, can feel sad about the loss of those hopes. That does not mean that “boob nazis” made them feel guilty and should just stop it with the baby-friendly bullshit already. It doesn’t mean that formula is supernifty and that we should let formula companies engage in deceptive marketing practices and co-opt hospital staff. It means we should support those women and help them work through their sadness so that they can move forward feeling good about themselves as mothers. It means that we should work harder to offer donor milk so that if those mothers are helped by knowing their baby is still getting breastmilk, they have the option to choose it. It means we should continue to research ways to help women so that they ARE able to reach their breastfeeding goals.

I am just tired of this argument. I’ve said it before, and I’ll say it again: when we hate on breastfeeding initiatives like baby-friendly, we hate on the very things that make it possible for women to breastfeed. An individual woman’s feelings of being judged or of guilt are REAL issues that deserve their own space and time (that’s why I just gave them their own paragraphs). But they are not the same thing. They are different. Different things. The end.

(As I was finishing this up, I saw that Gina at the Feminist Breeder has also written a post prompted by those blogs, "Why I’m a Feminist AND a Lactivist", and I highly encourage you to go and check it out.)

Breastfeeding and Feminism, Day 2 (...2 weeks later)

My Lent resolution has apparently not yet translated into more posting! A few factors have contributed to that, among them my new full-time job(!) I have gone from per diem at the hospital working 24ish hours a week, to full-time working 36 hours a week (three 12-hour night shifts). Going from working 8-hour shifts to 12-hour shifts is a surprisingly big adjustment (although fortunately not as big an adjustment as beginning to work nights was.) There are drawbacks to my new schedule (less flexibility, losing several evenings, etc.) but the benefits are, well, the benefits! Apart from my grad school assistantships, I haven't had a job with health insurance since I was in AmeriCorps. I am looking forward to having good health insurance, along with retirement benefits. One of my goals in going to grad school was to finally get a "real" job with salary + benefits, and while it didn't happen in exactly the field I expected it to, I couldn't be more pleased (except for the part where I work nights. Hopefully someday I'll work days again!)

Now that I've made my excuses, long-delayed highlights from the second day of the Breastfeeding & Feminism conference:

* Possibly my favorite presentation of the day was Robbie Davis-Floyd's report on the International MotherBaby Childbirth Initiative. Based on the Baby-Friendly initiative, the IMBCI has outlined 10 Steps to optimal motherbaby maternity services, developed with the input of organizations around the world. Steps include treating every woman with respect and dignity, offering continuous labor support, providing evidence-based practices, and providing access to emergency OB care. Three sites have applied and been accepted to become demonstration sites, one each in Austria, Brazil, and Quebec, Canada. You can read more about the (very diverse!) demonstration sites here. She discussed more about the sites and more details of their applications. She also talked about sites that will be added soon, in South Africa, Mozambique, India, and - amazingly - the largest maternity hospital in the Philippines, which does 22,000 births a year (I cannot even imagine). It's inspirational to see institutions from countries with different levels of development and each with their own unique strengths and challenges, working on the aim of improving maternity care. I am so excited to see ow the demonstration projects go.

* Michelle Lauria, an OB-GYN from Dartmouth, gave a great talk on reducing late preterm birth, a project of the Northern New England Perinatal Quality Improvement Network. She also talked about eliminating elective inductions before 39 weeks, and in mothers who do not have a high enough Bishop's score. She said the key is to put power in the hands of the nursing staff with the hospital authorities backing them up; the doctors know if they send someone in for an induction who does not meet the guidelines, the charge nurse will send them right back home. She talked about the next step being setting stricter guidelines on ways that some doctors use to get around the restrictions; she gave the example of mildly elevated blood pressures without proteinuria being called pre-eclampsia and used as a reason to induce early.

She also discussed VBAC at some length. Her take on it was, in her region, it's all about the money - as in, medical malpractice insurance costs. In northern New England, which has a lot of isolated rural communities, she gave an example of a small regional hospital that wants to offer VBACs but would have to pay $120,000 more in malpractice insurance to do so. Given that they anticipate 2 VBACs a year, they would end up paying an extra $60,000 per VBAC. Her proposed solutions are both governmental: either medical malpractice reform of some kind, or for the government to coordinate regional VBAC centers. There would be one hospital in each region designated as the VBAC center, and all the other maternity hospitals would contribute towards the VBAC center's additional malpractice insurance. She considers this unrealistic without government intervention because of the nature of competition between hospitals.

* Beverly Rossman from Rush in Chicago did a very inspiring presentation on breastfeeding peer counselors in the NICU. The NICU breastfeeding peer counselors are truly peers - they are women who have personal breastfeeding experience with very low birthweight (VLBW) babies. She summarized some themes from qualitative interviews from mothers who worked with the peer counselors: instrumental support, emotional support, finding hope, empowerment, community, and emulation. Over and over again the interviewees talked about how much they identified with the peer counselors, how much hope they drew from seeing mothers who had been in their situation, and how important the emotional support was. It left me wanting a breastfeeding peer counselor program in our NICU so badly! (If you'd like to learn more and you have access to the Journal of Human Lactation, you can check out their journal article. Citation: Rossman, Meier, Engstrom, Verheed, Norr & Hill. "They've Walked in My Shoes": Mothers of Very Low Birth Weight Infants and Their Experiences with Breastfeeding Peer Counselors in the Neonatal Intensive Care Unit. JHL. 2011. 27(1):14-24.)


It was a great conferences with some great conversation! It was hard to choose between the CIMS and the BF & Feminism tracks sometimes because there was so much interesting stuff going on, but I'm glad they combined the conferences for the opportunity to pick and choose from both programs.

Sadly, I won't be able to go to the CLPP Reproductive Justice conference this year. Please, everyone who's going tell me all about it! I am determined to go next year.

Breastfeeding & Feminism: Day 1

I really need to take more notes at these things! So here are a few notes pulled out of my very scattered information overloaded brain:

- Eugene Declercq gave a great keynote on statistical trends in C-sections, VBAC, and other birth-related stuff. One of the most interesting sections was on homebirth. Still very tiny numbers, so hard to identify a definite overall upward trend, but it seems to be on the rise. He then broke the trends out by race, and that was fascinating: homebirth rates were the same or dropping for all races except for white women, who are clearly seeing an uptick. He reports that in the latest stats, 1% of all births to white women happened at home. That seemed high to me, but apparently that's what the statistics are telling us. I am not at all surprised, however, by the disparity.

- Bettina Lauf Forbes and Danielle Rigg of Best for Babes spoke about reframing breastfeeding, including how much they dislike the phrase "protect, promote, and support breastfeeding" - they want to replace it with "inspire, prepare, and empower moms". They really have a marketing mindset of helping introduce moms to breastfeeding via common consumer culture avenues like celebrity profiles, then help educate them on avoiding the "booby traps". As they pointed out, we have very high BF intention rates - we need to help moms achieve their personal goals!

- Keren Epstein-Gilboa, who came all the way from Canada, gave a really dynamic talk on breastfeeding and envy. She first had us imagine something that we really, really wanted - a job, a person, a house, whatever - and say how it made us felt. (Great!) Then we had to think about how we couldn't have it - and how that made us feel. (Well, pretty crappy.) Now how did we feel about that thing, and the person who had that thing instead of us? We often tell ourselves we didn't want it anyway, or that it really isn't that great, or we try to break it into parts. She used that introduction to discuss her research on the relationship of fathers to breastfeeding, and how different societies treat mothers and by extension how they treat breastfeeding, and also what it means for women who try to breastfeeding and aren't able to. I only wish she'd had more than 15 minutes!

That's all for now - I've got to start recharging my brain for tomorrow...

Upcoming plans

So last year, I gave up Facebook for Lent, deciding I was letting it suck too much of my time. It was a surprisingly scary thing to do at the beginning! I really, honestly found myself getting kind of anxious when the time came to log out for the last time. And then...yeah, it was totally fine. I kind of forgot it existed, and when the time came for me to get back on I would go days before remembering to log in again. It was nice!

Of course, since then my usage has crept up again and realizing Lent was coming up, I thought about it and decided to take another Facebook break this year. Along with an even scarier one... blog reading. I do love Google Reader... maybe a little too much. I find myself spending hours consuming and clicking and reading and thinking, which is all well and good, but can spiral into way too much time, and in the meantime I'll "star" a dozen more to go back and read in more depth, or as inspiration for a post of my own, etcetera and those just pile up. The productivity scale goes way down the farther I get sucked in. You all know how it is, right? This just seemed like a good opportunity to give it a break and see what else I can do with that time.

So if I'm a regular commenter on your blog and am quiet for the next, oh, 40 days or so - you have your explanation! And while I am giving up blog reading, I'm not giving up blog writing and in fact hoping that this break gives me more time to work on posts I've been letting sit for a long time. Hopefully you'll see a little more content here!

In non-Internet-related news (although hopefully a post-generating activity) I will be going to the Breastfeeding and Feminism/CIMS conference this Friday and Saturday. Very excited! Anyone else planning to go?

I am still thinking about attending the CLPP Reproductive Justice conference in April. I am really hoping to be able to go. I can't say enough good things about this conference - each time I've gone has been a fantastic experience. If I make it, I'll definitely be posting here about it!

That's all for tonight...just posted my Facebook farewell and am ready to begin my Internet fast!