NYC and Breastfeeding
July 30, 2012 9:35 PM   Subscribe

During his tenure as Mayor of New York City, "public health autocrat" Michael Bloomberg has attempted to regulate trans fats, smoking and sugar-filled sodas. Now, he has a fresh target: moms who don't breastfeed. Beginning September 3, NYC hospitals participating in a new, voluntary program: Latch-On NYC (press release / posters / FAQ -pdf-), will make formula less accessible, to encourage moms of newborns to breastfeed instead of using formula.

Participating hospitals will no longer give away free formula sample packs or allow formula-related advertising to be displayed. Reportedly, formula samples will be locked away and only made available to infants if medically indicated, or if the mother requests it. However, a mother will be required to listen to a "mandated talk" from a staff member or nurse about why breastfeeding is better. Formula use will also tracked, and each bottle accounted for.

"In 2011, Rhode Island became the first state to end the widespread practice of giving away free goody bags of formula to mothers and their babies. Months later in July, Massachusetts followed suit."

The CDC on the benefits of breastfeeding. CBS News: Breast-Feeding State by State: Who's #1?

Incidentally, US hospitals that accept and give away free formula samples cannot receive Baby-Friendly Hospital designation, established by UNICEF/WHO. More.

Related editorials:
NY Times: The Milk Wars
Jezebel: New York City Will Encourage Moms to Breastfeed by Locking Up All the Formula
NY Post: Mayor Knows Breast
Gothamist: Wet Nurse Bloomberg Wants Hospitals To Lock Up Formula To Encourage Breast Feeding

Finally, a recent study indicates that the trans fat ban is having the desired effect. No word on whether hizzoner's giving up his trans fat-laden snacks any time soon, though. ;)
posted by zarq (220 comments total) 18 users marked this as a favorite

 
My wife had a C-section, and her milk didn't come in for a few days. Without that free formula sample we'd have never heard the end of my baby's screaming.

Terrible one-size-fits-all policy that doesn't even make sense on its own terms.
posted by gerryblog at 9:45 PM on July 30, 2012 [39 favorites]


I don't know enough about Bloomberg to know the specifics here, but, in general, I think this is the right approach. Our national diet is a health crisis. It is not enough to simply declare that it is a matter of personal will and personal failure. Our restaurants are feeding us food where one meal has enough calories for an entire day, enough salt for two days, enough sugar for a week.

We have a long history of being able to regulate food. I don't think things will change until we start regulating. Our country is going to be poisoned by the food we eat.
posted by Bunny Ultramod at 9:46 PM on July 30, 2012 [14 favorites]


This might be a pretty good idea. Formula is provably worse than breast milk, and formula manufacturers have been known to use ruthless tactics to promote their product (see the Nestlé boycott).
posted by Joakim Ziegler at 9:47 PM on July 30, 2012 [5 favorites]


You know, Breastfeeding doesn't always work out for everyone. There's plenty of people for whom, for one reason or another, it doesn't work out and formula ends up being their option, despite trying hard and going through all kinds of pumps and mechanical contrivances to try and make it happen.

So I'm all for encouragement of breastfeeding, and to a certain extent preventing companies pushing formula upon new mums, but really additional shaming and inconvenience is not required.
posted by Artw at 9:47 PM on July 30, 2012 [95 favorites]


However, a mother will be required to listen to a "mandated talk" from a staff member or nurse about why breastfeeding is better. Formula use will also tracked, and each bottle accounted for.

A father will be required to listen to a "mandated talk" from a staff member or nurse about doing 100% of the housework. Dishes and laundry will be tracked, and each unwashed item accounted for.
posted by milk white peacock at 9:49 PM on July 30, 2012 [55 favorites]


mothers who insist on bottle-feeding will still be able to do so, but nurses would have to sign out the baby formula, which would always be on hand for mothers who have difficulty breast-feeding.

I guess you pay for that? Dunno, this doesn't affect me in the least but I want to understand Bloombeg's thinking on this.
posted by Ad hominem at 9:49 PM on July 30, 2012


Participating hospitals will no longer give away free formula sample packs or allow formula-related advertising to be displayed. Reportedly, formula samples will be locked away and only made available to infants if medically indicated, or if the mother requests it. However, a mother will be required to listen to a "mandated talk" from a staff member or nurse about why breastfeeding is better. Formula use will also tracked, and each bottle accounted for.

In this paragraph you can see the policy ranging from the perfectly sensible (no advertising) to the totally bonkers (each bottle accounted for). Why not just eliminate the formula-pushing stuff, and leave it there?
posted by feckless at 9:50 PM on July 30, 2012 [21 favorites]


I am not a mother. But if I were, although I would agree that breast feeding is best, I suspect I would punch a man in the face* if he lectured me on the virtues of breastfeeding while simultaneously not taking steps to ensure that the world made it easier for me to do so. It's easy to shame mothers but somehow not easy to make the world easier to be a mother.

*I know, I know: violence is bad. But there is something about men lecturing women on the glories of breastfeeding that brings out the rage in me. The sodding lecturing has been going on since the Romans and probably before and it always involves shaming women for being selfish or stupid or dumb or just plain wrong.
posted by lesbiassparrow at 9:51 PM on July 30, 2012 [38 favorites]


Sound like a great idea. Why do we subsidize formula in the first place?
posted by 2bucksplus at 9:51 PM on July 30, 2012 [3 favorites]


Nanny Bloomberg, stay out of my hospital room! I don't want the mayor mandating what healthcare workers say to patients. I just had a baby and every worker I came in contact with provided excellent care and it's not because the mayor was breathing down their necks. Let providers do their jobs and use their own judgment- hell, let moms do that, too.
posted by ThePinkSuperhero at 9:52 PM on July 30, 2012 [12 favorites]


Ah, the good old US of A. A government that can afford to berate and shame new mothers, but which won't actually pay for their health insurance.
posted by Joe in Australia at 9:53 PM on July 30, 2012 [95 favorites]


I would have no problems with this were I a USian. As it stands, I suspect this is already the policy in Canada. When our first was born at BC Women's Hospital and we had problems feeding, we we offered donated breast milk rather than formula - and we were very grateful for it. Don't recall anyone mentioning formula at all during our stay. We aren't nipple nazis and do use formula on occasion but all evidence suggests that breast feeding should be encouraged.

I can see how breast milk donation schemes might be incompatible with for-profit healthcare, though...
posted by pascal at 9:53 PM on July 30, 2012 [5 favorites]


It's a rare, nearly exact parallel to sledgehammer-style abortion legislation from the right. Just let the doctors run the hospitals!
posted by gerryblog at 9:54 PM on July 30, 2012 [3 favorites]


Our restaurants are feeding us food

No, individuals are ordering and consuming certain foods at restaurants. Take some responsibility and butt out of people's lives.

Encouraging women to breastfeed is fine. Restricting their access to formula is paternalistic, authoritarian horseshit. It's death by a thousand cuts to the notion of individual responsibility and freedom - it's not the place of the state to tell women that they can't feed their children formula. One day we all wake up in a world where our behaviour is restricted not based on what harms others, but based on the legislated lifestyle preferences of our enlightened rulers, enacted solely for our own good, don't you know. Lifestyle totalitarianism - coming to an overtired, stressed out mother who wants to make up her own damn mind how to raise her child near you.
posted by Dasein at 9:56 PM on July 30, 2012 [27 favorites]


Oh my god the framing of this post is ridiculous. The giveaways to formula industry are absolutely staggering, and the disinformation campaign against breastfeeding is constant.
posted by odinsdream at 9:57 PM on July 30, 2012 [39 favorites]


We have a long history of being able to regulate food. I don't think things will change until we start regulating. Our country is going to be poisoned by the food we eat.

I'm really curious to know how moms whose babies don't latch on will be treated. My kids were 4 weeks early, and refused to latch on. My wife pumped to bottles for over three months before we switched to formula. Now, in theory this is the best possible alternative to breast feeding: the twins are getting mom's milk even though they were too young to take it directly from the nipple. Yet my wife was made to feel like an inadequate parent by lactation consultants for ostesibly doing the right thing, and not trying to force my kids to do something they simply weren't ready for.

I think the concept comes from a good place. But for heaven's sake, shaming women who have already been through nine months of pregnancy -- especially new moms who are often dealing with hormonal changes and other issues -- is a really shitty thing to mandate.

Gothamist:
"Participating hospitals will still give formula to mothers who request it, but with every bottle they request, staffers will explain why she should offer the breast instead. Gothamist Executive Editor Jen Chung, mother of one, shared her mixed feelings with us: "For many women, breastfeeding is HARD, that's why there are lactation consultants who charge like $175/private visit or $35 for a 15-minute phone call after you leave the hospital. And when the breastfeeding isn't going well, it really makes the mom depressed. For some moms and babies, it's easy, for others, it's harder. I definitely think moms should give it a try for as long as they can but they shouldn't feel like terrible mothers if they can't or that the hospital/medical professionals won't support them. Keeping formula 'locked up' is also weird — moms could just make their partners/friends buy it from the drug store.""

posted by zarq at 9:59 PM on July 30, 2012 [15 favorites]


Oh my god the framing of this post is ridiculous.

Then as the OP, let me encourage you to either complain in Metatalk or add constructively to the discussion taking place here. I spent a lot of time composing this, trying to make sure that there was as little hyperbole and bias as possible -- no easy feat considering the topic and emotions involved. If I wasn't successful, then mea culpa.
posted by zarq at 10:01 PM on July 30, 2012 [22 favorites]


Women's bodies are always regulated as part of a nationalist impulse. I'd argue that the obese body is implicitly "feminized" in popular discourse and regulated in the same way. Women and feminized people can't be trusted with their bodies; women and feminized people are a threat to the body of the nation (as I think Bunny Ultramod's comment upthread makes clear - a "we" which is quickly figured as the nation, usually the nation in crisis).

Blech.

As usual, there's no move to give people more choices, more control, more autonomy from capitalism; there's only a move to force them to be better capitalist producers - in this case, better and more tractable reproducers of labor. "Health" as civic/capitalist duty.
posted by Frowner at 10:02 PM on July 30, 2012 [23 favorites]


Dunno, I don't care what people feed their babies but every account says something different. I can't imagine it is as dire as it seems. Isn't everything "locked up" and accounted for in hospitals? Don't they also give you stern warnings about risks on just about everything?
posted by Ad hominem at 10:03 PM on July 30, 2012 [4 favorites]


the disinformation campaign against breastfeeding is constant.

This was not our experience being pregnant this last year. The push to breastfeed exclusively was overwhelming, even in the face of my wife's milk being late, baby's acid reflux preventing her from latching and drinking properly, and my wife's never producing enough. The current attachment parenting movement/fad is deeply shaming for any woman who chooses, or is forced, to supplement, much less go to formula exclusively.

The pressure to breastfeed-only was so overwhelming that it never even OCCURRED to us, in the face of our baby's constant hungry screaming, to give her a bottle. When a nurse finally told us, when we called the emergency line in a panic at 4 AM our first night from the hospital, that we should just give the baby formula, it was like a dam burst. Oh right. That's why we have those bottles down there.

Meanwhile, I was an exclusively formula-fed baby, and brain my fine works hamburger. Breastfeeding is obviously good, and should be encouraged, but there's no need for this kind of hysteria. /Hamburger.
posted by gerryblog at 10:04 PM on July 30, 2012 [41 favorites]


the campaign telling women they're doing it wrong is constant. forbid the advertising, support the mothers (lactation consultants for all, provide access to midwives/doulas, etc), and realize there isn't a one size fits all on any topic that relates to a child.
posted by nadawi at 10:09 PM on July 30, 2012 [16 favorites]


Frankly, I think forbidding advertising in hospitals is an overall good policy, no matter whether it's about formula or medicine or whatever. Let hospitals be places where people go for treatment and procedures, not places people go to have products shove themselves at the patients as things they should be asking about.
posted by hippybear at 10:12 PM on July 30, 2012 [26 favorites]


You know what's super fun? Jaundice.
posted by Artw at 10:12 PM on July 30, 2012 [7 favorites]


I can't say I know much about any disinformation campaign against breastfeeding. When I had my son ten years ago the "breast is best" people were on the job, ready to shame and manhandle me from the moment he was born. Of course, even when my baby was drastically losing weight because I couldn't produce enough milk, the lactation consultant was there to lecture me for doing it wrong, even though I was following her advice to the letter.

Getting rid of advertising for formula seems fine and reasonable, but a lecture every time someone requests formula? My god, that's ridiculous and cruel to new moms. Give people the information to make an informed decision and leave it at that.
posted by madelf at 10:14 PM on July 30, 2012 [29 favorites]


Under the new program, reported by the New York Post, mothers who insist on bottle-feeding will still be able to do so, but nurses would have to sign out the baby formula, which would always be on hand for mothers who have difficulty breast-feeding.

Notorious NYC facist mayor would require you to ask for something in order to get it. The horrors of our kapitalist kleptocracy never cease. What further indignities will we have to suffer next? Will Herr Bloomberg require us to say please when asking?
posted by Winnemac at 10:14 PM on July 30, 2012 [4 favorites]


Breastfeeding, just another way to feed your baby those essential fat soluble toxins (BPA, PCBs to name drop the ones people will recognize) you've been bioaccumulating for the first X decades of your life one mouthful at a time.
posted by Slackermagee at 10:15 PM on July 30, 2012 [7 favorites]


I suspect I would punch a man in the face* if he lectured me on the virtues of breastfeeding while simultaneously not taking steps to ensure that the world made it easier for me to do so.

For what it's worth, at the hospital where my kids were born, the people who talked to us about breastfeeding were all women, and they went to a great deal of effort to make it easier for mom and baby to do so. I don't think that's so unusual.
posted by escabeche at 10:18 PM on July 30, 2012 [3 favorites]


The formula companies all say "breast is best" right there on the package. But they also dump off cans of free starter formula on your doorstep the second they find out you had a kid.

Breast milk is pretty much free IF you can get things going well, but in my experience observing the difficulty my wife had, it is not easy, and it is pretty easy for those who can afford the stuff to give up and go with the formula. But half the reason it isn't easy is because the formula companies broke the breast feeding tradition, we didn't have mothers and aunts and grandmothers who can help women through the early steps, and we are far short on siblings or friends who can fill in for mom while her milk comes in. This used to be normal.
posted by caution live frogs at 10:18 PM on July 30, 2012 [8 favorites]


As someone who breastfed both of my children for over a year each, YOU CAN PRY MY FORMULA FREEBIES FROM MY COLD DEAD HANDS. They saved me from being rehospitalized when a super-hungry baby was too demanding for me to keep up with whole healing from a difficult C-section and formula's expensive, yo. With both boys, we took the excess freebies and donated them to the battered women's shelter and crisis nursery where there is always, always a need for abused infants being removed from bad parents and abused women afraid to leave abusive partners because they can't afford to feed their babies.

I also experienced an absolutely overwhelming and propagandiatic demand that I breastfeed that was heavily focused on how bad a mother I would be if I didn't breastfeed for at least a year. The lactation consultant attempted to take away my post-surgical pain meds ("bad for baby!") without consulting my doctor, talked to me like I was four, and pre-emptively pronounced me a "failure" as a mother for being open to the idea of formula. And yes, this was the HOSPITAL-EMPLOYED lactation consultant. A friend of mine was angrily approached in the mall by a lactivist for giving her baby a bottle at the mall, accusing her of child abuse for refusing to breastfeed. Her baby was a foster child in her care because of actual abuse.

There's so much guilt, propaganda, and unsupported bullshit from lactivists that its completely absurd. It made it basically impossible for me to ask for any help with breastfeeding because they were SO FUCKING MEAN. And I had a comparatively very easy breastfeeding experience. I can't imagine what its like if you struggle and the mean boob brigade is there to harangue you.
posted by Eyebrows McGee at 10:18 PM on July 30, 2012 [71 favorites]


Isn't everything "locked up" and accounted for in hospitals?

I just had a baby in an NYC hospital. Formula in ready to use, single servings was in the drawer of the baby's bassinet, along with the diapers, wipes, etc.
posted by ThePinkSuperhero at 10:22 PM on July 30, 2012 [3 favorites]


Why do we subsidize formula in the first place?

Well, in theory, the US subsidizes formula use through the Special Supplemental Program for Women, Infants and Children (WIC) because it is to the greater civic good to ensure that children living in poverty aren't malnourished. The subsidy isn't in preference to breastfeeding, since mothers who use formula are eligible for food assistance on their own behalf (in addition to the child's) only for the first six months postpartum and those who breastfeed are eligible for a full year postpartum. (This is because WIC is explicitly about the nutrition of children, and women are included only because biological mothers play an integral role in infant nutrition.)

But this isn't about that. Quite the contrary - this is about preventing formula companies from using hospitals and birthing centres as a point of distribution for free formula as a loss-leader marketing promotion. Formula companies are paying to play, not being subsidized.
posted by gingerest at 10:24 PM on July 30, 2012 [7 favorites]


I like this:
Participating hospitals will no longer give away free formula sample packs or allow formula-related advertising to be displayed. Reportedly, formula samples will be locked away and only made available to infants if medically indicated, or if the mother requests it.

I really dislike this: However, a mother will be required to listen to a "mandated talk" from a staff member or nurse about why breastfeeding is better..

Post-birth is a delicate time, for everybody, and harranguing from well-intentioned strangers is the last thing anyone needs, esp with a side-serving of guilt. A brochure, or something is better. Also, one-size-fits-all is so crappy for this stuff.

That all said, I find sentiments like this quite interesting: Nanny Bloomberg, stay out of my hospital room!

You are outraged by the presence of a public health official with the aim of improving outcomes being in the hospital room, but are presumably inured to the presence of nestle et al in there? If only in goals, one is a government trying (albeit hamfistedly) to improve health outcomes, the other is there to make money. If we're kicking things out of the hospital room, I know where I would start...
posted by smoke at 10:25 PM on July 30, 2012 [22 favorites]


My wife had a C-section, and her milk didn't come in for a few days. Without that free formula sample we'd have never heard the end of my baby's screaming.

Wait, don't they sell formula in stores?
posted by Sara C. at 10:25 PM on July 30, 2012 [7 favorites]


Our son was born three weeks premature and couldn't latch on to save his life (literally). Thank Whomever that we had an incredible midwife with decades of experience, not to mention the rest of her team, and some savvy medical practitioners who helped us navigate latch-on techniques, pumping and yes a modicum of formula until we could get the first two sussed out.

We needed that supplementation of formula to get through the first two months or so, yet I'm in favor of Bloomberg's efforts. I understand that some moms can't or won't breastfeed for a myriad of reasons. But breast milk has been designed by millions of years of evolution to provide the sustenance that baby needs, and that formula can (as of yet) only aspire to. Breastfeeding provides intimacy and comfort that I can only begin to imagine. We phased out the formula as soon as we could, grateful that it helped our son through the rough patch, but not missing it when our supply ran out.

None of this matters in the first few weeks of parenthood. You just want to keep your kid alive. Formula has its place. I'm confident that some of us are alive and reading Metafilter now because our parents had access to it. But having been through the whole birth in a medical facility experience, I think that Nature has to remain part of the system and process. Some of the best facilities and practitioners remember this. Not all of them do.
posted by vverse23 at 10:27 PM on July 30, 2012 [1 favorite]


I just had a baby in an NYC hospital. Formula in ready to use, single servings was in the drawer of the baby's bassinet, along with the diapers, wipes, etc.

So that is what they mean by the "swag bag" or whatever. So now you get a lecture and get to pay probably a couple hundred bucks a pop for the privilege. Fuck Bloomberg on general principals.
posted by Ad hominem at 10:28 PM on July 30, 2012 [1 favorite]


Formula shouldn't be provided for free to people who can breastfeed, or to people who can't breastfeed but who can afford formula for themselves. That practice is a sop to the companies that make formula, and it's harmful in all kinds of ways.

The lecture-every-time thing is ridiculous, though. It's like Bloomberg thought "this law is too reasonable. I have to add something that people can fight about."
posted by gurple at 10:29 PM on July 30, 2012 [6 favorites]


FYI: Chicago is also considering this.

The University of Chicago Hospitals does not lock up baby formula, but is developing a policy that would require either a doctor’s order to begin formula feeding or documentation that a nurse counseled the mother on the benefits of breastfeeding over formulas, according to hospital spokeswoman Tiffani Washington.

NorthShore Hospitals keeps formula unlocked but in a location only accessible with help from a nurse.

posted by IndigoRain at 10:29 PM on July 30, 2012


"Target"? Please. For years the hospitals would coerce women into using formula instead of breastfeeding. He's simply removing the coercive factor of it (free formula samples for everyone). If a woman's not planning to use formula, why throw crap at her she doesn't need, and which is less healthy for the baby that breast feeding.

It's not like he's outlawing it. Women who state they are choosing to not breastfeed will have the same access.
posted by Lt. Bunny Wigglesworth at 10:33 PM on July 30, 2012 [6 favorites]


I agree that this seems very nanny state, and the value of the program not proportional to its costs. The cost of course, is that mothers who are having difficulties don't have a simple fallback, and will be frustrated and have unhappy babies.

It seems to me, that the education component is perfectly reasonable without the draconian locking up of every last bottle of formula. Give them the facts, then a package of formula in a "break glass in case of emergency" package. It's more sympathetic and empowers people to make their own choices.
posted by CheeseDigestsAll at 10:34 PM on July 30, 2012


Gurple, that's a good point. Pointless whining/"controversy" has been a part of so many Bloomberg policies that on paper seem inherently sensible. The man can get people bitching about how terrible parks are and how much they wish people would eat more junk food. I wonder if there's a strategy here? Is it reverse psychology or something?

Also, it seems folks are misreading something that's right there in the FPP -- it says formula will be available if medically indicated. I think babies who have trouble latching on due to being premature would probably count as medically indicated. They're not going to let preemies starve on principle. Gah.
posted by Sara C. at 10:35 PM on July 30, 2012 [8 favorites]


That practice is a sop to the companies that make formula, and it's harmful in all kinds of ways.

Putting Bloomberg's policies into one grab-bag of authoritarianism is odious particularly for these reasons. Regulation of food and food safety are important components of the public health policies of any elected official.
posted by Blazecock Pileon at 10:37 PM on July 30, 2012 [7 favorites]


mothers who are having difficulties don't have a simple fallback, and will be frustrated and have unhappy babies.

Doesn't the average new mom stay in the hospital for like 2-3 days, tops? We're not talking about angry starving 6 month olds, here. Once folks get home, they can buy all the formula they want. And it sounds as if it will be available for the asking in the hospital. Not to mention, if a new mom is so afraid of the "harrangue" from hospital staff, presumably she could have someone bring formula in from outside.
posted by Sara C. at 10:38 PM on July 30, 2012 [4 favorites]


get to pay probably a couple hundred bucks a pop for the privilege.

The things you need for a new born baby that would last a week or so would maaaaybe be fifty bucks. Maybe. You seem very opinionated for someone with little familiarity in this arena, it seems.
posted by smoke at 10:38 PM on July 30, 2012


We were sent home without any indication that formula would be medically indicated. I suppose I could have gotten to a store at 4 am, but I'm glad I didn't have to.

Sending formula home with use-this-if-you-need-it instructions would have been the best thing for us. The just-wait-for-the-milk advice was worse than useless. Kids and pregnancies are all different; you need flexibility, not mindless rigidity.
posted by gerryblog at 10:39 PM on July 30, 2012 [4 favorites]


My wife had a C-section, and her milk didn't come in for a few days. Without that free formula sample we'd have never heard the end of my baby's screaming.

I highly doubt the nurse would have gone, "oh, there's no milk? Well, we'd love to give you formula, but we don't have free samples from multiple manufacturers, so you're out of luck!"

Not every hospital patient requires jello, but the hospital provides jello to the patients that need it, and they aren't just free samples.
posted by Lt. Bunny Wigglesworth at 10:41 PM on July 30, 2012 [3 favorites]


I would also hazard a guess (though I admit it's just a guess) the "breast is best!" lecture would be downplayed if women are having actual physical problems that are preventing them from feeding.

...of course, that depends on the nurse.
posted by Lt. Bunny Wigglesworth at 10:43 PM on July 30, 2012


documentation that a nurse counseled the mother on the benefits of breastfeeding over formulas

it's that language which does my head in. how about "a discussion about why the parents/mother are considering formula." you can tell people all day long that breastfeeding is better (all things being equal, which they rarely are), but what good does that do someone who is sleep deprived and potentially dealing with a wide assortment of problems. i feel like these sorts of laws/guidelines are written by people who have never had to deal with negative sides of the complexities of breastfeeding.
posted by nadawi at 10:45 PM on July 30, 2012


Highly doubt it all you like but that is exactly what happened. Multiple lactation consultants told us to wait for the milk. We went home from the hospital with those instructions, and followed them diligently until 4 am the next night.

Our baby wouldn't have gotten sufficient nourishment for another 24 hours after that without formula.
posted by gerryblog at 10:45 PM on July 30, 2012 [1 favorite]


Reportedly, formula samples will be locked away and only made available to infants if medically indicated, or if the mother requests it. However, a mother will be required to listen to a "mandated talk" from a staff member or nurse about why breastfeeding is better.

Yes, because clearly can't trust women to make the best decision for their children on their own, especially not those kind of women, you know who I mean.

That part rings alarm bells for me, as it feels similar to the old abortion talk, where you can have an abortion, but you first have to listen to somebody tell you there are alternatives and are you sure blahblahblah, all supposedly for your own good but in context clearly meant to shame and guilt trip you into not going ahead with it.

Meanwhile the institutional barriers for anybody but rich middle class women to actually breastfeed are left intact: hostility against breastfeeding in public, lack of pregnancy leave and so on.
posted by MartinWisse at 10:46 PM on July 30, 2012 [29 favorites]


Yeah, it's hard not to personalize this. My wife fully intended on breastfeeding our son, but he just could not get the hang of it despite extensive, but ultimately unsuccessful, coaching from the lactation consultant. Our son's failure to take to breastfeeding already caused a reasonable amount of frustration and upset to my wife; I don't see how adding another layer of shame by forcing her to specifically request formula and receive a "you're doing it wrong" lecture for her efforts would have improved things.
posted by The Gooch at 10:50 PM on July 30, 2012 [8 favorites]


I agree that this seems very nanny state

This may seem like a "nanny-state" scenario, but you know what nannies do? Prevent kids from shoving crap food into their mouths twenty-four hours a day without eating any veg. Prevent kids from being mean to babies. Prevent kids from bullying others. Prevent kids from shoving their fingers into sockets.

When you're able to not do those things on your own is when your parents determine you don't need a nanny.

....if we're not able to make responsible decisions on our own, maybe that's the reason the state's acting like a "nanny"
posted by Lt. Bunny Wigglesworth at 10:51 PM on July 30, 2012 [1 favorite]


The things you need for a new born baby that would last a week or so would maaaaybe be fifty bucks. Maybe. You seem very opinionated for someone with little familiarity in this arena, it seems.

I'm trying to figure out what the articles are talking about. With the new procedures don't you think the price of a carefully accounted for bottle of whatever will cost more? And the lecture isn't going to be free, that is time out of somebody's schedule. The patient is going to be billed for all this.

As for my opinion, I am trying to understand the latest move in Bloomberg's master plan. He is my mayor, I am interested in what he is doing in my city.
posted by Ad hominem at 10:53 PM on July 30, 2012


"Wait, don't they sell formula in stores?"

Yes, but imagine you're a first-time father with a drugged post-surgical wife and a screaming hungry infant at home, both getting more upset by the moment, and you're facing a wall of 40 kinds of formula at the only 24-hour drugstore within a 30-minute drive. At 3 a.m. While sleep-deprived. (I suppose in NYC there's always somewhere closer than 30 minutes away that's open 24 hours.)

I realize that the entire purpose of the freebies is to get you hooked on Brand X (because if it works, why switch?) in those first few days, but the thing is IT REALLY HELPS to have a few servings of formula on hand if you need them. Going out to buy bottle #5 is no big deal. Going out to buy bottle #1 is a crisis.

Also, most doctors don't allow new mothers to drive for a while. Not all women have support at home after giving birth. Even if they have partners, their partners may have to go back to work immediately, stranding them at home with no way to get to a store. I was not allowed to drive for six weeks. We do not have grocery delivery where I live. My husband went back to work the day after we came home from the hospital. How would I get to the store to get formula?

Also, the most helpful breastfeeding support I got was actually from the Enfamil booklet about breastfeeding that came with the free formula sample (and the breastmilk storage containers, and the cold paks, and the insulated breastmilk transport bag for pumped milk. I still use the cold paks and the transport bag, they're great.). It was 10 times as helpful as anything else but KellyMom. From the breastfeeding support people we contacted before my C-section, I got told that if I "chose" to go ahead with a C-section, I "might not bond with [my] baby," because the C-section would prevent adequate breastfeeding (no help on how to get around that! Just that the C-section was a bad idea!) and we'd therefore never be able to bond. I said well, if I don't have the C-section, I definitely won't bond with my baby because I'll be DEAD, and they had no help to offer me. (Also, CLEARLY AND OBVIOUSLY, in their scheme of the world, no adopted person has ever bonded with his or her adoptive parents.)

Until breastfeeding support can be supportive of MOTHERS, and remotely based in evidence, and working WITH doctors instead of undermining what they're telling their patients, it's useless to say, "oh, breastfeeding is awesome, women can do it, yay!" Many women simply don't have the PRIVILEGE of breastfeeding because of social structures that prevent it -- not formula companies, but unfriendly family leave policies, unfriendly workplace pumping policies, etc. Attacking individual women for choosing not to breastfeed for economic and social reasons within such a family- and woman-unfriendly structure is wrongheaded and cruel. And even if you have the privilege of breastfeeding if you so choose, the support that's available is uneven and frequently provided by crazy people. Because the people who feel the most strongly about breastfeeding are the ones who become lactation consultants, I get it, but that doesn't necessarily make them good resources for struggling mothers, and the moralistic, absolutist, angry, overwrought tone that lactivists take is rotten. Really rotten. It makes people cry, constantly. I have basically no friends who gave birth who weren't made to cry by a lactation consultant. They undermine doctors -- ob/gyns and pediatricians both -- they harangue, they make totally unsupported claims and give unscientific advice.

"...of course, that depends on the nurse."

Indeed. When I said I was TRYING BREASTFEEDING and if we had trouble (which for various reasons was somewhat likely, though in the end it worked out fine) we would be open to formula, she told me I was BREASTFEEDING WRONG by BREASTFEEDING. I got a twenty-minute lecture, while in a great deal of pain and very drugged up, about how my ATTITUDE TOWARDS BREASTFEEDING was completely incorrect and unless I was 100% committed to it, no matter what my husband, mother, doctor, or pediatrician said, there was no way I'd be successful at it, and by my attitude alone I was short-changing my baby.

(I had a nicer lactation consultant my second time, but I refused to be in the room alone with her, because the first one was SO CRAZY and kept trying to take advantage of my emotional and drugged state and was really manipulative. It was crazy. Lactation support was far and away the worst part of my birth experience. Worse than the hospital food. I was afraid it would happen again and so the second time I would only let her talk to me when I had a family member there. It's really wrong that I felt I had to do that.)

Some minimal and enforced standards for breastfeeding counseling seem necessary before requiring breastfeeding counseling for everyone.
posted by Eyebrows McGee at 10:54 PM on July 30, 2012 [64 favorites]


Meanwhile the institutional barriers for anybody but rich middle class women to actually breastfeed are left intact: hostility against breastfeeding in public, lack of pregnancy leave and so on.

Fixing any of that would be hard and impressive. The shaming bullshit on the other hand is cheap bullshit.
posted by Artw at 10:54 PM on July 30, 2012 [9 favorites]


....if we're not able to make responsible decisions on our own, maybe that's the reason the state's acting like a "nanny"

Are you talking about feeding babies formula? It's not irresponsible at all. Calling it irresponsible is, in fact, so detached from the reality of modern NYC motherhood that it becomes a general insult.
posted by the young rope-rider at 10:57 PM on July 30, 2012 [18 favorites]


I am not a mom. But a new mom I know showed me a schedule today of her baby's breastfeeding. I think she said her baby is trying to increase supply right now, and her schedule showed that for most hours of the day, baby is feeding 45-50 minutes out of every hour. Her breaks are often 15-20 minutes. That is insane to me and I'm not sure I could do it if I was a new mom, already struggling with hormones and sleep-deprived. It would be nice to know even in the hospital, that I didn't have to go asking permission for formula and face a lecture too. (In regards to the Chicago link I posted where they want you to have a doctor's note.)

Also regarding that Chicago link, I can just picture being in the hospital with a screaming hungry baby, you want to breastfeed but your milk hasn't come in yet, and nurse says "oh, well sorry we have to call the doctor before we can give you formula" and then (even unintentionally) taking an hour to make that call while you struggle with said screaming baby. I sure hope you have someone to bring you in formula from the outside. I think I'd make sure to have the doctor's note ahead of time no matter what I was planning.
posted by IndigoRain at 10:58 PM on July 30, 2012 [3 favorites]


Not every hospital patient requires jello, but the hospital provides jello to the patients that need it, and they aren't just free samples.

No, I'm pretty sure if you look at your hospital bill closely, you will find each serving of jello costs about $20.
posted by hippybear at 11:01 PM on July 30, 2012 [2 favorites]


Our baby wouldn't have gotten sufficient nourishment for another 24 hours after that without formula.

I do not understand how your baby was in the hospital for 3 days (standard for uneventful C-section) with no food. If your wife was not expressing at all and the nurses did not provide formula during your hospital stay, and encouraged you to not use formula at home despite your protestations (I assumed you protested?) you should sue for negligence.

Anyway, my point is the only formula in existence that you can feed your baby is not the free samples. If you're concerned your baby has been in the hospital for 3 days with no food, get thee to CVS.
posted by Lt. Bunny Wigglesworth at 11:04 PM on July 30, 2012 [2 favorites]


Ever since my grandmother told me that with her first baby, her nipples immediately cracked wide open and bled like a stuck pig and her milk never even came in, I've figured any new mom that chooses not to breastfeed probably has decent reasons for doing so, and far be it from me, a person without an infant latched to my breast, to tell them that they're a bad mother or that they're endangering the health of their baby. How the hell would I know? I'm not any new mom's doctor, you know?

This just seems like such a bad idea. Sure, keep the aggressive marketing campaigns out of the hospitals, but locking up the formula and lecturing a new mom every time she needs to use it is just another excuse to shame women for not being fucking perfect every second of every day.
posted by palomar at 11:06 PM on July 30, 2012 [7 favorites]


Where have people been reading that the formula won't be free any more? If patients are going to be charged for formula, we've just swapped economic coercion to formula-feed for economic coercion to breastfeed, which is not an improvement.

Why does every intervention to protect children turn into a way to reduce the autonomy of their mothers?
posted by gingerest at 11:07 PM on July 30, 2012 [1 favorite]


They thought the collostrum was enough. The baby disagreed.

But, sure, the thing that happened to us probably didn't happen and anyway it was our fault.
posted by gerryblog at 11:08 PM on July 30, 2012 [15 favorites]


No, I'm pretty sure if you look at your hospital bill closely, you will find each serving of jello costs about $20.

Sorry - for some reason I'm just not seeing where I said the jello was free of charge, only that it was on hand.

It's another item you are using from the hospital. Of course you should pay for it.

(and $20 jello? What hospital did you go to?! Sign me up! My hospital charged $5 for 3 courses)
posted by Lt. Bunny Wigglesworth at 11:09 PM on July 30, 2012 [1 favorite]


"I do not understand how your baby was in the hospital for 3 days (standard for uneventful C-section) with no food. "

Milk frequently doesn't come in after a C-section until day 3 or 4. Mine didn't come in until late in the third day with my first baby, and the doctors were totally unconcerned about it, it's very normal.

"If you're concerned your baby has been in the hospital for 3 days with no food, get thee to CVS."

As above, please explain to me how if I were a mom at home alone with a new baby, who is not allowed to drive (and on vicoden to boot!), I would be able to get myself to a CVS.
posted by Eyebrows McGee at 11:09 PM on July 30, 2012 [10 favorites]


The problem is not with women choosing to use formula.

The problem is with companies pushing formula on new moms through a variety of direct and indirect means, both obvious and subtle.
posted by five fresh fish at 11:10 PM on July 30, 2012 [8 favorites]


I feel like half the outraged commenters in the thread have barely read the OP, let alone the links. Emphasis mine:
"Michael Bloomberg has attempted to regulate trans fats, smoking and sugar-filled sodas. Now, he has a fresh target: moms who don't breastfeed."
I'm not sure how these things are the same. Bloomberg isn't regulating formula or breastmilk.

"NYC hospitals participating in a new, voluntary program"
Voluntary! They don't have to participate.

Reportedly, formula samples will be locked away and only made available to infants if medically indicated, or if the mother requests it."
Just ask, and they will bring you formula. Is it too hard to ask? I don't understand the outrage.
posted by Joh at 11:10 PM on July 30, 2012 [10 favorites]


Gingerest, I think the issues are getting mixed up here. There are 2 separate issues at hand: Putting away formula so you have to ASK for it and possibly get a lecture, and the other issue of free formula samples in gift bags. I'm not sure the formula bottles in the baby's bassinet that are readily available are free. Like the jell-o, they probably charge you for it.
posted by IndigoRain at 11:11 PM on July 30, 2012


Sara C. wrote: Doesn't the average new mom stay in the hospital for like 2-3 days, tops? We're not talking about angry starving 6 month olds, here.

No. We're talking about newborns who may not have been able to latch on at all and are getting dehydrated; and it's 4 AM, your breasts are literally bleeding, you've already had literally months of breastfeeding education plus free and paid-for lactation consultants, but your baby is still crying.all.the.time because she's thirsty. Her urine is so hyper-concentrated that her diapers aren't wet; they just have a sort of streak of uric acid crystals in them. The nurses are too scared to say anything because they've had the lectures too, but you can tell they're worried. But sure, let's wait until another lactation specialist comes in at 8 AM to tell you that you just need to keep trying! before glaring at you and letting you sign for a single serve of formula. And you can repeat this every couple of hours because newborns need to feed very frequently, and you can stay polite and civil to the gatekeepers of the baby formula even though you haven't slept since the night before the delivery.

That's what we're talking about.
posted by Joe in Australia at 11:13 PM on July 30, 2012 [28 favorites]


Yes, but imagine you're a first-time father with a drugged post-surgical wife and a screaming hungry infant at home, both getting more upset by the moment, and you're facing a wall of 40 kinds of formula at the only 24-hour drugstore within a 30-minute drive.

As someone who's been in this position, I have to say that I found the choice of formula much less difficult than the choice of sanitary towel. What governs the different categories? Size? Circumference? Why have I never had this discussion before today?
posted by PeterMcDermott at 11:14 PM on July 30, 2012 [6 favorites]


Yo, we might want to dial down on the passive aggressiveness in here. Everybody knows breast v formula is fraught with tensions at the best of times, with women on both sides being shamed and harasssed for their choices, please do not add to the tension.
posted by MartinWisse at 11:15 PM on July 30, 2012 [3 favorites]


It seems from the FPP that formula use would be encouraged where medically indicated. If a baby isn't able to latch on or the mother isn't able to pump, that sounds like the definition of medically indicated.

People are getting extremely hysterical here in ways that just aren't warranted from the actual text of the FPP, let alone the news link, let alone what the actual policy really says and/or how it will actually be implemented. It's possible, I grant, that this will be used in the absolute most ham-fisted possible way as a tool to shame women. That is a thing that happens, and something we should be vigilant of. But there's little in the actual post that implies that the explicit purpose here is for hospitals to be ham-fisted shame-mongers.
posted by Sara C. at 11:18 PM on July 30, 2012 [3 favorites]


[A couple of comments deleted; Lt. Bunny Wigglesworth, you need to find a way to communicate here that doesn't look like you are accusing people of lying about their own experience. Everyone: let's keep this from getting personal, thanks. ]
posted by taz at 11:22 PM on July 30, 2012


Yep, this is the sound of the pendulum swinging too far.

Every pregnant woman I take care of has heard about the benefits of breast feeding many times by the time they get to the hospital. Some women choose to supplement, especially in the early days when their milk isn't in, they're exhausted and hurting. Some women come from countries where they've seen children die from starvation or dehydration. We educated and we support, but I absolutely resent the fact that my hospital now requires a doctor's order to provide formula, something that is rarely medically indicated, but certainly within a parent's rights. Our patients can't even provide formula from home without a doctor going on record as saying this is a good idea.

I recently saw a three month old baby that weighed eight pounds. The parents were experienced, educated, and motivated, and working really hard at nursing but they'd had it ingrained in them from day one, that anything other than breast milk was evil and they had been totally blinded to the fact that their child was dying from malnutrition. It took a week of convincing them, that if this was the third world, hers would be one of those babies that wouldn't make it to their first birthday. The baby's gaining weight now, but it will be months before he catches up and his neurological status is impossible to predict.

Yeah, stop the freebie formula, even cajole parents a little bit, but an outright ban is a dangerous development.
posted by Slarty Bartfast at 11:23 PM on July 30, 2012 [14 favorites]


The FAQ included in the FPP above is very informative about the purpose of this policy and what it specifically entails.

Lectures in return for every request for formula are not mentioned in the FAQ. Neither is the requirement that hospitals lock formula away. It seems to very literally be about not pushing formula samples, not supplementing with formula behind the mother's back, not administering medications that will dry up milk supply without discussing it with the mother, respecting mothers' choice to breastfeed, giving women 24 hour access to their babies, and other totally rational things like that.
posted by Sara C. at 11:26 PM on July 30, 2012 [6 favorites]


Going slightly meta bout the various Bloombergian measures, what I've liked about his earlier measures was that he shifted the burden of "junk food avoidance" from the individual to the sellers/manufacturers, which is where it should be, by e.g. forcing them to be honest about the calories and fat and such in their products.

What these breast feeding measures do is the opposite, making it more difficult to get formula by making parents jump through more hoops to be able to get it. It's the pernicious fetishism of personal responsibility again, when there are institutional barriers against people doing the right choice they have to overcome through sheer willpower and to encourage them, let's take away their alternatives.
posted by MartinWisse at 11:26 PM on July 30, 2012 [2 favorites]


The most objectionable parts of this regulation might be sacrificial offerings to the outraged, and not intended to become ultimate law. Gotta have some negotiating room!
posted by five fresh fish at 11:31 PM on July 30, 2012


Lectures in return for every request for formula are not mentioned in the FAQ.

Lectures are just a terrible thing when you just want to feed your baby. I see lectures here in the FAQ:
When the decision to supplement is not medically indicated, efforts to educate the mother should be documented as well by the nursing and/or medical staff.
Neither is the requirement that hospitals lock formula away.

What is this?
Restricting access to formula means storing formula away from where it is easily visible and accessible to staff and mothers. Access to formula is restricted by both:

• Storing formula in a locked location, such as a storage room, cabinet or an automated medication system or, storing formula in a location outside, but reasonably near, the maternity unit, AND.
• Limiting the number of hospital staff with access to formula by implementing a system to identify which hospital member accessed the formula supply; some examples are a log book, a code or a key system.
All of this just seems to be making things more difficult.
posted by Danila at 11:37 PM on July 30, 2012 [9 favorites]


Storing formula in a locked location, such as a storage room, cabinet or an automated medication system or, storing formula in a location outside, but reasonably near, the maternity unit, AND.
• Limiting the number of hospital staff with access to formula by implementing a system to identify which hospital member accessed the formula supply; some examples are a log book, a code or a key system.


Thanks for pointing out the FAQ, it clears up all my questions.

So on one hand it could be in a closet with a log book, on the other it could be in a automated medication system requiring a code or key. So hospitals have a fair amount of discretion.
posted by Ad hominem at 11:37 PM on July 30, 2012


Going slightly meta on the breastfeeding, #2 has been a demanding baby whom I breastfed 3,651 times in ten months. 12 times a day, every day, for ten months. Every two hours. Around the clock. I'm exhausted and all of my joints ache all of the time.

He slept five hours at 11 months and started slowing down, and we're down to one feeding a day at 14 months.

But I'm sick to.death of breastfeeding. I've been pregnant or breastfeeding for four solid years. People shouldn't have to do this if they don't want to. It's hard and wearing and wearying. I miss bras without flaps.

But wake and feed, wake and feed, every two hours, for ten solid months. 3,651 times. It's appalling. I'm exhausted. But I'll miss it. I'll be sorry so see him my toddler now. And when will I surf metafilter when not nursing?
posted by Eyebrows McGee at 11:39 PM on July 30, 2012 [5 favorites]


I'd like to point out that either way you're taking up time nurses could be spending on more important tasks than fetching baby formula.
posted by maryr at 11:39 PM on July 30, 2012 [9 favorites]


I had a no-you-stink comment deleted above, probably rightly, but I just wanted to take a bit of it and put a period on my own story that framed some of the above discussion.

As Eyebrows McGree noted, milk can take its time coming in after a C-section. Before the milk comes in, the mother produces a pre-milk substance called collostrum. The lactation consultants we worked with felt that this was sufficient to tide the baby over; the baby, as I mentioned, had other ideas. babyblog lost slightly more than the recommended amount of weight in the first few days after pregnancy, but in the end this was not a major crisis; I suspect the baby's health was not seriously as risk. But she did need formula, despite the stern advice of the lactation nurses in the hospital, and I am glad wehad a free sample to use that first very bad night at 4 AM.

This is a very common post-C-section experience, which means it's likely to occur to some degree or another in upwards of one-third of pregnancies. It's perfectly fine to say "hey, just go to CVS," but many people can't, especially not in the very difficult days immediately after a birth -- and it seems unfair to criticize people for not buying the formula you're not supposed to use in advance of the need you don't expect to have. I think breastfeeding is actually best, and support encouraging breastfeeding, absolutely -- but a policy that strives to actively keep formula out of the hands of mothers who might discover they need it strikes me as pretty obviously excessive, and honestly cruel to new parents who have literally no idea what they're doing and are petrified of somehow doing the wrong thing.

Of course you can say "but they could just ask for formula!" or "the policy doesn't actually mandate pro-breastfeeding lectures!" What I and other people in the thread have been trying to communicate is that even in the absence of such a policy, we got the absolutism and the lectures. New parents often feel tremendous pressure to never use formula under any circumstances. When I saw this post on the FP I was genuinely horrified at the idea that you'd want to put even more pressure on desperate new parents for whom the use of formula may be necessary. There are all sorts of pregnancies, and all sorts of new babies; it's not something you can have just one policy about.
posted by gerryblog at 11:40 PM on July 30, 2012 [8 favorites]


Sorry, guys, it seems like I didn't read the whole FAQ.

However, even going back and seeing what I missed, it still sounds really reasonable.
posted by Sara C. at 11:41 PM on July 30, 2012 [2 favorites]


I agree that under the best case scenario this could be reasonable. Under the worst case scenario I really think this could break some people.
posted by Danila at 11:48 PM on July 30, 2012 [4 favorites]


I'd like to point out that either way you're taking up time nurses could be spending on more important tasks than fetching baby formula.

Isn't fetching baby formula part of nurses (or other hospital staff)'s job?

I mean, I guess every hospital room should be equipped with everything a patient could ever want, just to save nurses time they could spend doing other stuff?

Granted, I don't have kids (*ducking*), but I presume that the nurses in a maternity are human beings. So, couldn't you just say, "we've decided not to breastfeed, thanks", and specifically request the formula, and half-listen to the half-assed breastfeeding "lecture" that isn't actually mentioned in the literature*, and then proceed to do the formula thing from there on out? Surely only the most rule-obsessed Nazi of a maternity nurse is going to give a full on Three Minutes Shame to every mother at every feeding.

My mom is a nurse, and a former lactation consultant, and will happily talk your ear off about the benefits of breastfeeding, but I can't imagine even she would be willing to harangue every mom in the maternity ward on an hourly basis before just getting the damn formula.

*What's specified is encouraging breastfeeding. Which, are people really suggesting that hospitals shouldn't encourage breastfeeding and shouldn't tell patients about the benefits of breastfeeding?
posted by Sara C. at 11:49 PM on July 30, 2012 [1 favorite]


But people have told you what they've experienced, including exactly those sorts of overkill lectures from hostile lactation consultants, all in the absence of a bold new initiative that would further empower them.

Why does this seem so implausible to people that it keeps being doubted? There's a lot of weird, patronizing behavior directed at pregnant women and new mothers from all corners. This is just the tip of the iceberg.
posted by gerryblog at 12:00 AM on July 31, 2012 [7 favorites]


Calling it irresponsible is, in fact, so detached from the reality of modern NYC motherhood that it becomes a general insult.

For the love of...! I'm saying shoving free samples of a substance nutritionally less valuable than breast milk - when for years it's been touted as being more nutritional than breastmilk - sans the a talk about how the past misconceptions are just that - misconceptions - under women's faces when they're already exhausted from childbirth is irresponsible.
posted by Lt. Bunny Wigglesworth at 12:02 AM on July 31, 2012 [1 favorite]


A lot of the focus on restricting access to formula seems to be on restricting it from nurses, not restricting it from mothers.
posted by Sara C. at 12:02 AM on July 31, 2012 [3 favorites]


Yeah, this is some incredible paternalistic bullshit. WTF, NYC?
posted by 2N2222 at 12:03 AM on July 31, 2012


i would favorite maryr and danila's last comments a million times.

every mother should have a big huge support system and easy breastfeeding and all the time in the world to rest and babies that sleep in big chunks and adequate leave and no negative stereotypes about public breastfeeding. i would support the hell out of that. i'm never having kids, but i really believe that it's in society's best interest to support new parents.

what i don't support is giving people more encouragement to lecture new moms without giving them real help.
posted by nadawi at 12:03 AM on July 31, 2012 [7 favorites]


Since we're filling the thread with anecdata, I had a c-section, and couldn't breastfeed my severely underweight son at first. The lactation consultants and the nurses all tried their best to help me, the LC brought me a pump to use, and she also suggested I supplement with formula. The lactation consultant suggested it. That's right, not all LCs are terrible, shaming monsters. The nurse went to the cupboard (locked? I don't know) where they keep the formula, and brought it to me to feed my son. I'm sure she had to note it down and track it just like every other hospital supply. I feel like the outrage in this thread is just assuming the worst of healthcare professionals who, in my experience just want to help, and were kind and loving and encouraged me to breastfeed, but most of all, they put my sons needs first. As the LC said, the most important thing is to feed the baby. I hope that the majority of nurses and LCs behave like mine did, and I hope that all the terrible stories above are the exception, not the rule. I think that bad healthcare professionals are terrible, but this story is not about bad healthcare professionals, its about trying to encourage breastfeeding.
posted by Joh at 12:05 AM on July 31, 2012 [1 favorite]


what i don't support is giving people more encouragement to lecture new moms without giving them real help.

Which has nothing to do with the actual policy.
posted by Sara C. at 12:05 AM on July 31, 2012 [1 favorite]


we disagree about that.
posted by nadawi at 12:07 AM on July 31, 2012


A lot of the focus on restricting access to formula seems to be on restricting it from nurses, not restricting it from mothers.

I agree with that but I would like to see real current data about the veracity of the implied narrative (hospital staff too lazy/overworked/owned-by-the-Man to help mother breastfeed sticks bottle in baby's mouth without family's permission, ruins baby's latch.)
posted by gingerest at 12:08 AM on July 31, 2012


Sara C., I think you're putting too little weight on mothers' state of mind and failing to consider the limited resources of a nursing ward - particularly when the hospitals themselves will be discouraged from supplying formula. The policy doesn't guarantee that hospitals will have people available 24/7 with the power to authorise the supply of formula; it doesn't say that women shall only be lectured once; other posters have referred to the abuse they have received from the lactation gestapo - for what it's worth, one of them told us that by feeding our daughter a soy-based formula we would be making her infertile. If she'd actually been on our ward I bet we'd have been lectured every single time.

So when the typical new mother (who has probably already had months of lactation lectures) finally can't cope and pleads for some relief - do you really think that a nurse will brightly say "Oh! Of course dear! I will just go and get you some formula!" It is much, much easier for people to say no than to say yes, and the roster of people who can say "no" keeps changing so there's always someone new who wants you to keep trying for just another shift so she doesn't need to document the fact that the hospital ward has another Bad Mother. If this policy is imposed on hospitals then I bet babies will be left to suffer until a senior nurse intervenes, and if the new mother is wise and determined enough to request formula that request will have to be passed up the line to a doctor or lactation consultant, who will not necessarily be available on short notice. And then the mother will be lectured.

Honestly, this is pretty much what happened with us even without an official policy of locking up the marvellous baby juice. We had the indrawn breaths, the lectures, everything. Our first baby would have died without formula. My wife was in tears when her very sensible lactation consultant told her that of course she shouldn't be trying to breastfeed any longer; that she didn't need to keep spending hours with a pump (more time pumping than resting!) to extract a few precious drops of milk.
posted by Joe in Australia at 12:13 AM on July 31, 2012 [10 favorites]


I believe Michael Bloomberg is still a Republican, covertly working to discredit Liberalism by promoting all its least-popular features (paternalism, restrictions) while suppressing the stuff people like about it.
posted by Harvey Kilobit at 12:17 AM on July 31, 2012 [1 favorite]


All of the lactation consultants we worked with were well-intentioned people trying to do what they thought was best. All of them were seemed very nice. But they were strict absolutists about breastfeeding when the situation really didn't call for it, and my wife doesn't have nearly as many kind things to say about them as I do.

But it's certainly true that not all LCs are monsters. I happily concede the point! I've only argued for flexibility in the face of the oncoming storm called new parenthood.

Sorry to have posted so much but this hit a nerve I didn't know I had. Goodnight all.
posted by gerryblog at 12:19 AM on July 31, 2012 [3 favorites]


A government that can afford to berate and shame new mothers, but which won't actually pay for their health insurance.

Nice and pithy sounding. The mayor of New York is not employed by the United States government, however. And municipal governments, even NYC's, don't regulate health insurance or any sort of insurance, can't start offering their own, etc. States regulate insurance. Sorry to be a pithy political statement party pooper, and to use alliteration while I'm at it.
posted by raysmj at 12:23 AM on July 31, 2012


Which, are people really suggesting that hospitals shouldn't encourage breastfeeding and shouldn't tell patients about the benefits of breastfeeding?

I'm starting to wonder if people think all women know exactly how their bodies work....they don't. Most people don't know all about how their bodies work, female or male.

Some women know breastfeeding is healthy, but not how much. Other women know exactly what's going on. Some women are still under the decades-old "formula is best" and believe the whole breastfeeding thing is part of icky attachment parenting, ew.

Handing out free samples of formula, along with the "necessities" (wipes, binkies, etc) makes the formula seem more like a "necessity" and actively goes against the "breast is best" message.

zarq - Sara C brings up a good point - you mention in your post there's a mandated lecture on the benefits of breast-feeding, but I'm not seeing that in the linked-to NY articles. Was that from another article you saw? Could you link to it?
posted by Lt. Bunny Wigglesworth at 12:23 AM on July 31, 2012 [3 favorites]


My own anecdotal experience, as someone who is entirely pro-breastfeeding (pro-whatever age, pro-feeding anywhere) was that the PRO breastfeeding side was the source of strident propaganda and dogma, that (again, in my own experience) seemed harmful and disproportionate to the occasional and half-assed anti-breastfeeding sentiment I encountered.
posted by zippy at 12:35 AM on July 31, 2012 [4 favorites]


The "mandated talk" language comes from Huffington Post, and they're getting their info from the New York Post here:
With each bottle a mother requests and receives, she’ll also get a talking-to. Staffers will explain why she should offer the breast instead.

“It’s the patient’s choice,” said Allison Walsh, of Beth Israel Medical Center. “But it’s our job to educate them on the best option.”

Lisa Paladino, of Staten Island University Hospital, said: “The key to getting more moms to breast-feed is making the formula less accessible. This way, the RN has to sign out the formula like any other medication. The nurse’s aide can’t just go grab another bottle.”
posted by Danila at 12:35 AM on July 31, 2012


What about breastmilk banks? Is that like, too old fashioned or something?

I've always viewed formula as a supplement, not necessarily a replacement.

I don't get the negative reaction here.

And can I ask that we actively discuss the subtle facets of shaming instead of just stating it with absolute rightness? Sometimes I feel like the "you're shaming" card is used too readily to silence healthy debate on a contentious issue.
posted by roboton666 at 12:39 AM on July 31, 2012 [4 favorites]


In related news, NYC is also going to change its official motto to "The city that never sleeps because it's constantly worried that one of its 8 million people is making an unhealthy choice."
posted by MattMangels at 12:54 AM on July 31, 2012 [4 favorites]


I think the idea of a mandated educational effort comes from page 3 of the FAQ: "It is the responsibility of the health professional to provide information, document parental decisions, and support the mother after she has made this decision. When the decision to supplement is not medically indicated, efforts to educate the mother should be documented as well by the nursing and/or medical staff."

The idea that it's going to happen with every bottle probably comes from page 7, which says, "If the mother still insists on receiving formula, document it in the chart along with the reason and distribute only the amount of formula needed for the feeding." It's an alarmist reading.

I was thinking about ways to make breastfeeding easier, and looked into the labor laws in New York state. A nursing mother is guaranteed 20 minutes of unpaid break time (30 minutes if the pumping room is far away from the workstation) every 3 hours, for up to 3 years after the birth, and protect breastfeeding mothers against firing. On the other hand, there's no enforcement provision - litigation is going to decide whether employers break the law or not.
posted by gingerest at 1:12 AM on July 31, 2012 [1 favorite]


Camels milk is actually better than formula. It is what's used in Saudi Arabia if a baby can't have it's own mother's milk. It's the closest animal milk to human equivalent.

I breast fed successfully with both children. No advice, no consultants, but I did not work outside the home. It makes a difference.
posted by Katjusa Roquette at 1:25 AM on July 31, 2012


Part of me is glad these public health issues are getting discussed more, and part of me wants Mayor Bloomberg to die of hypoglycemia surrounded by diet sodas.

Not everything can be legislated better. I'm all for breast milk banks, but the level of paternalism and disrespect involved in this kind of policy is a little breathtaking. Also, I'm pretty sure that most new mothers will already have an informed opinion on the importance of breastfeeding before they even go into the hospital to deliver the baby. Not that I know anything on the subject.
posted by BrotherCaine at 2:25 AM on July 31, 2012


Oh, I wish you were around me 14 years ago, Lt. Bunny Wigglesworth.

You could have enjoyed the experience of a newborn crying to be fed 20 minutes after she finished her last feed. For six straight weeks.

I don't even fucking remember most of her newborn weeks, because I was so sleep-deprived. I had a doctor shout at me that I was starving her because the breast-nazi's had me so convinced that I had to breastfeed and if I resorted to formula, I was the worst mother in the world.

Now that child is about 180cm tall, in the gifted-and-talented class at school, drop-dead gorgeous, and I'm incredibly proud of her. And if she struggles to breastfeed her children, I'm going to tell the Leche League to stay the fuck out of the bra of my daughter and the needs of her child... if a baby is hungry, they need to be fed, and formula is a hell of a lot better than nothing.
posted by malibustacey9999 at 3:07 AM on July 31, 2012 [7 favorites]


After my wife's c-section we had exactly the same kind of appointment with exactly the same kind of monstrous "lactation consultant," whose advice was that we should keep trying and not worry that there was no milk, nothing, not even a drop and that our daughter screamed bloody murder any time a nipple was within 5 feet of her face. So eventually we threw her out (the consultant, not the baby) and offered formula, and nothing dire happened during the five days it took for the milk to finally arrived.

Thing is, we're educated people and we already know about the benefits of breastfeeding. We bought the usual baby books and actually read them. But we're also not the target audience. There are PLENTY of people in NYC who would never even think of breastfeeding, and who live in neighborhoods where very few people do so. It's all formula. I know, because that's the kind of household I grew up in, and those are neighborhoods where I lived.

I don't like this set of paternalistic stuff any more than I like paternalism in general. However, we need to remind ourselves that no, mothers don't always know what's best. No one is born with this knowledge, it's learned in a social setting and much of what is learned can be wrong. This policy doesn't sound like a response to the early feeding trauma some of the moms in this thread have experienced, but to the large population of moms who don't know about breastfeeding and/or would never even think of giving it a shot. I don't understand why this is about "personal choice." Society has an interest in babies being as smart and healthy as possible.
posted by 1adam12 at 3:26 AM on July 31, 2012 [4 favorites]


I am a nurse (although not a maternity nurse) and I have to say that I'm really turned off by the hyper-evangelism of the "breast is best" crowd. I think people comparing this to "you have to have a lecture and see an ultrasound image prior to an abortion" are right on the mark. The role of health professions is not bully people (especially vulnerable people like new mothers), it's to provide education so that consumers can make informed choices. This is just more paternalism dressed up in a cause du jour, and I'm sick of women's bodies and health (and that of their babies) being politicized battle-ground for everyone with an agenda.
posted by supercrayon at 3:30 AM on July 31, 2012 [27 favorites]


I don't envy the health care workers who will have to lecture hormonal exhausted new moms......
posted by St. Alia of the Bunnies at 4:09 AM on July 31, 2012 [2 favorites]


Lots of focus on the lecture. It's a bad idea. The real point of the law is to eliminate the giveaway formula. Liberal, educated middle class folks like the cohort here are not the target of this legislation. Most of us know breast feeding should be the default option so the choice to use formula is made when breast feeding isn't working as well as it should. Bloomberg isn't trying to end that. He's trying to end people who can breast feed from choosing formula. Those people tend to be concentrated among the poorer and less educated. This isn't about villifying somebody from Park Slope with a baby who can't latch. I can see why some people have that reaction and obviously it's an emotional issue. It seems if there is a real problem it is how the legislation is worded not the intent.
posted by JPD at 4:30 AM on July 31, 2012 [10 favorites]


I first read the post as saying "Bloomberg has attempted to regulate train farts."
posted by Kirth Gerson at 4:33 AM on July 31, 2012 [1 favorite]


What JPD said. This is basically a piece of welfare reform, targeted in fact at minority mothers on Medicaid or without insurance and probably motivated by some findings about racial disparities in early childhood health outcomes, much as the over 16 oz soda ban was motivated by the high rates of diabetes and hypertension (and high Medicaid and charity care costs) among blacks and Hispanics.
posted by MattD at 4:51 AM on July 31, 2012 [1 favorite]


I first read the post as saying "Bloomberg has attempted to regulate train farts."

Bloomberg will meet his match in the form of Big Train Fart.

(cut to mustachioed robber barons cackling evilly around a poker table)
(they are played by George Carlin, Peter Fonda, Alec Baldwin, et al.)
(Pinkerton thugs hold Thomas the Tank Engine captive in chains, forcing him to fart into a special container marked "STANDARD TRAIN FART CO.")
(his eyes roll around in forlorn pain as every last ounce of his strength is converted into valuable, valuable train farts)
(this is the second-weirdest episode of Thomas the Tank Engine ever)
posted by Sticherbeast at 5:02 AM on July 31, 2012 [2 favorites]


To 1Adam12's point - I have a buddy who is Archie Bunker Irish-Catholic from Queens. Two young kids at home, they breastfeed. His mother will intentionally leave out the breast milk his wife has pumped and left for the kids when she goes to work because "Breastfeeding is for Animals" and "Formula is better."
posted by JPD at 5:03 AM on July 31, 2012 [3 favorites]


Personally, I would have loved to have gotten a free formula sample at the hospital when I gave birth. Instead, since it took my milk 5 days to come in and my baby was losing weight at an alarming rate... my husband had to go out in the middle of the night to buy some formula.

(And this was at our midwife's insistence...people always think midwives are breastfeeding Nazis, but ours was just focused on the health of the baby above all else. What a concept. We just supplemented for 24 hours until my milk finally came in.)

After all the stress of a difficult birth, and the feelings of failure since my milk didn't come in right away and I had sore bleeding nipples, I would not have been impressed to hear a lecture once it came time to supplement with formula.
posted by barnoley at 5:05 AM on July 31, 2012


The comments are just more evidence that this is a very loaded subject.

I don't see anybody being forced to do anything.

New York is perhaps the most fiscally-challenged major city in the United States, which is due not least to the cost of public health and social services. Bloomberg is attacking the problem at the best possible place. The science doesn't lie on this: all other things being equal, the child's odds of being healthy are better if nursed. Plus, breast milk is free. Rather important if you're poor.

If a woman gives birth naturally and is otherwise healthy, then she is likely to be able to breastfeed, should be encouraged to do so and provided all the assistance she needs to make a go of it.

If there are complicating factors, then formula feeding is medically necessary and I can't imagine it ever being denied to a mother and child who need it.

Providing free formula samples by default, though, does encourage formula feeding. Why do you think formula manufacturers do it? Because it gives them a warm and fuzzy feeling inside?
posted by rhombus at 5:10 AM on July 31, 2012 [1 favorite]


So basically, Michael Bloomberg is to "public health" what Robert Moses was to automobile expressways?
posted by mediated self at 5:16 AM on July 31, 2012 [4 favorites]


zarq - Sara C brings up a good point - you mention in your post there's a mandated lecture on the benefits of breast-feeding, but I'm not seeing that in the linked-to NY articles. Was that from another article you saw? Could you link to it?

As gingerest notes, it's in the FAQ, on pages 3 and 7. Guidelines listed on page 3 come from the Academy of Breastfeeding Medicine's Clinical Protocols.

The idea that it's going to happen with every bottle probably comes from page 7, which says, "If the mother still insists on receiving formula, document it in the chart along with the reason and distribute only the amount of formula needed for the feeding." It's an alarmist reading.

I'd like to point out that I didn't say anywhere in my post that lectures were going to be given with each bottle of formula dispensed, primarily because the source for that claim was from a New York Post editorial, and... well... New York Post. I only included that link in the FPP because so many articles were referencing it, and I deliberately buried it so it wouldn't be more prominent.

However, it does not strike me as outside the realm of possibility that multiple lectures would occur. As has been mentioned by many people here, babies feed very frequently: every 2-3 hours. Nurses and lactation consultants work in shifts, and each new shift could conceivably bring a new request for bottles of formula, and a fresh lecture. Having been in this exact situation with with my wife after she gave birth to our kids, this does not strike me as alarmist. The lactation consultants were not supportive. She was lectured multiple times by several people.

Data points for the rest of the thread: My kids were in the hospital for 4 days. Twin birth, emergency c-section, so they stayed in the NICU longer. Both my kids were underweight when they were born, and then they lost weight after the birth. My wife pumped, then fed them breast milk through a bottle. This was also discouraged by several lactation consultants, one of which had the gall to tell my wife she was hurting my newborn children by not allowing them to bond with her physically -- a blatant lie. If my kids had failed to thrive, which might have been likely if they couldn't latch on and no bottle feedings (breastmilk or formula) were allowed, they could have remained in the hospital for a longer stretch.

Oh, and my wife also couldn't drive for 6 weeks after her c-section. I believe she was on vicodin or some other pain killer for at least a couple of weeks, but i could be remembering wrong. We had little outside help. Leaving 2 5lb newborn babies alone in the house with a woman drugged on pain killers to get formula would probably not have been a great idea.

I think this is a great concept. Encouraging moms to choose breast milk over formula is a good thing. Making formula less accessible to moms could help accomplish that. I have no doubt that many lactation consultants are fantastic and supportive people whose hearts are in the right place. But yes, there are also lactation consultants who are fervent bullies. Encouraging them to lecture newborn moms, not to mention pushing hospital staff to wait to dispense formula until a doctor authorizes it (as if doctors are always immediately accessible) strikes me as a bad idea.
posted by zarq at 5:25 AM on July 31, 2012 [5 favorites]



So basically, Michael Bloomberg is to "public health" what Robert Moses was to automobile expressways?


Totally. Breastfeeding Destroys Neighborhoods and the Cigarette Ban was expressly targeted not to help non-whites.
posted by JPD at 5:27 AM on July 31, 2012 [1 favorite]


Correction to above: my wife says she was on tylenol, and had been given a script for tylenol with codeine, but didn't take it for more than a couple of days after she left the hospital.
posted by zarq at 5:28 AM on July 31, 2012


My mother's state 3 cancer was found literally the morning I was born. It was recommended that she begin treatment immediately, and that treatment was not deemed safe for breastfeeding. So, I was a formula baby.

Generally, people say "oh, but that's different!" when I mention our circumstances. But why is it different? My mom could have foregone or delayed treatment and breastfed me for a while - obviously putting herself at risk, but given me breastmilk. When women become mothers, their sovereignty to also take care of their own wellbeing does not end - whether it's physical or mental or whatever. People paint women who give their newborns formula, as mothers that don't care or try hard enough, or lazy. Because I'll bet it feels AWESOME to have someone judge how inadequate of a parent you are, and how inadequate your breasts are, mere hours after becoming a mother. Congratulations on the birth of your child! You seriously suck at it! FSM forbid a mother want to feed her child in a way that she is best able to at that time.

I turned out alright. Healthy thus far at 32, Master's from Harvard. If formula has such an impact, maybe I have it to thank? Or more than likely, there are many, many other determiners that aid in a child's development that we should be focusing on.
posted by raztaj at 5:28 AM on July 31, 2012 [11 favorites]


Public Health planning by anecdote is probably not a good model.
posted by JPD at 5:30 AM on July 31, 2012 [2 favorites]


The problem is not with women choosing to use formula. The problem is with companies pushing formula on new moms through a variety of direct and indirect means, both obvious and subtle.

No, the problem is with a law requiring that when a woman sincerely does choose to use formula and is doing so based on actual and legitimate problems with producing milk, the doctor still has to sit her down and say "are you SURE you really tried breastfeeding right?"
posted by EmpressCallipygos at 5:38 AM on July 31, 2012 [3 favorites]


Lots of focus on the lecture. It's a bad idea. The real point of the law is to eliminate the giveaway formula.

Then they should have left the "mandated talk" part out of the law altogether. Period.
posted by EmpressCallipygos at 5:41 AM on July 31, 2012 [1 favorite]


Sara C., I understand that you think you fully understand this issue. Before I had a baby, I probably would have thought the same things relating to breastfeeding and this new law. But until you've been a new mom, with the mixture of total physical exhaustion and fluctuating hormones... and then to have things not work out the way you were expecting, which makes you feel like a total failure of a mother within the first week.... you really don't know how awful it feels for people to pile more "breast is best" talk on you.
posted by barnoley at 5:57 AM on July 31, 2012 [8 favorites]


No, the problem is with a law requiring that when a woman sincerely does choose to use formula and is doing so based on actual and legitimate problems with producing milk, the doctor still has to sit her down and say "are you SURE you really tried breastfeeding right?"

You know literally saying "are you SURE you really tried breastfeeding right?" will actually have a really meaningful impact on the % of woman who attempt breastfeeding.
posted by JPD at 6:14 AM on July 31, 2012


There is a 20 point gap in breastfeeding rates between mothers with a High School Diploma or less and mothers with an Undergraduate degree.

There is a 30 point in between mothers 30+ and <20 years of age.

African-Americans breastfeed at a rate 20 points below the rest of the United States.

That's what this is about.
posted by JPD at 6:28 AM on July 31, 2012 [3 favorites]


This policy definitely seems to be about providing mothers of newborns with the information and assistance necessary to help them with breastfeeding instead of just pushing formula into their hands.

It's not about making mothers with newborns feel bad about themselves if they have trouble with latch or feel like they need to supplement (although supplementation does have the tendency of reducing available supply). It's not about depriving newborns of calories when the situation warrants it (supply insufficient, multiple births, etc).

The medical evidence supporting breastfeeding instead of formula feeding is pretty significant. This is just one more brick in a foundation being laid to make breastfeeding the preferred method instead of the old default of just putting the kid on the bottle. No it's not going to make breastfeeding more logisitically realistic for new mothers but it might start reversing the tendency of formula first as the default in disadvantaged populations.
posted by vuron at 6:41 AM on July 31, 2012


The push to breastfeed exclusively was overwhelming, even in the face of my wife's milk being late, baby's acid reflux preventing her from latching and drinking properly, and my wife's never producing enough

I remember when my sister had her first girl, and the damn kid would not latch, would not suck, and all the lovely doctors and nurses said, 'Oh, she just needs a little time, if you use formula, she'll be lazy about feeding, give her time, she'll sort it out, don't use formula, breast is best." So my sister did not use formula. And so she felt like a shit brand-new mom, and was even more stressed out than exhausted brand-new moms tend to be, and her little girl is tired and hungry and cranky, and not gaining weight, and now the kid's losing weight, but with all the push breast-feeding got, she's getting the message You're Fucking Inadequate from all sides and finally, after my niece dropped a few pounds, the lovely doctors and nurses allowed that maybe formula would be a good idea.

Information is fine, education's fine. But piss on anyone who'd add to the stress and anxiety of a new parent that way, however well-intentioned they are.
posted by Alvy Ampersand at 6:46 AM on July 31, 2012 [8 favorites]


There is a 20 point gap in breastfeeding rates between mothers with a High School Diploma or less and mothers with an Undergraduate degree.

There is a 30 point in between mothers 30+ and


And how much of those gaps are due to differences in the kinds of jobs available to different groups of women as well as the ability to not work outside the home at all for a while? If I'm a Walmart cashier, I'm very much more unlikely to be able to breastfeed than if I can stay home with the baby for a year or two. How about making rules that force corporations to be more friendly to mothers who want to breastfeed rather than making already overburdened mothers feel even more guilty? If we want mothers to breastfeed more, how about making structural changes to the workplace and society that make it easier for them to do so, rather than this ridiculous fear-mongering bullshit?
posted by peacheater at 6:48 AM on July 31, 2012 [32 favorites]


I think making formula not the default is a good thing, but I already hear a lot of horror stories about lactation consultants who just won't leave some poor woman alone when breastfeeding turns out not to be easy, and it seems possible that this law is solving a problem that's already massively over-solved.

By all means, make formula not the default and don't hand it out like Tic Tacs, but treating it like a controlled substance and requiring recurring lectures to women who want to use it is just mean.

But if you really want to increase breastfeeding, America? You need to do something about your ridiculously awful and lame maternity leave policies.
posted by jacquilynne at 6:49 AM on July 31, 2012 [10 favorites]


In that case the concern upthread that this is lectures in lieu of actual material support seems pretty on-point. Many women who use formula do so for reasons other than raw ignorance, including many of the aforementioned one-third of women who have Caesarians. This policy doesn't lead enough space for those sorts of experiences. Education is good but the policy overdoes it by a good bit from where I'm sitting.

Nearly every person who has discussed this policy in this thread understands its goals and approves of them in the abstract. We have said so. What we are talking about is where we see the policy going too far in practice and making life worse for some new parents. I don't see how continued appeals to an idealized version of the policy, or its goals in the abstract, respond to those kinds of specific concerns that are being made.

We get that they want to do this for public health reasons. Honestly! But we can think it's wrongheaded despite that fact.
posted by gerryblog at 6:52 AM on July 31, 2012 [5 favorites]


But if you really want to increase breastfeeding, America? You need to do something about your ridiculously awful and lame maternity leave policies.

Slow down there, Stalin. The lectures and shaming are free!
posted by gerryblog at 6:55 AM on July 31, 2012 [10 favorites]


vuron: "The medical evidence supporting breastfeeding instead of formula feeding is pretty significant. This is just one more brick in a foundation being laid to make breastfeeding the preferred method instead of the old default of just putting the kid on the bottle. No it's not going to make breastfeeding more logisitically realistic for new mothers but it might start reversing the tendency of formula first as the default in disadvantaged populations."

This has been the case for over a decade now. When our daughter was born 11 years ago, my wife was treated pretty badly by nurses and multiple lactation consultants because she was unable to get our baby to latch on. There was definite shaming and some real guilt dished out. My wife and daughter struggled pretty badly for a couple of weeks before our (wonderful) pediatrician stepped in and gave us "permission" to switch to formula.

As gerryblog says, I know that in the abstract this is a great policy and a laudable goal, but in practice, I am already wincing in empathy for the moms and dads who will be given a healthy ration of shit because of it.
posted by Rock Steady at 6:56 AM on July 31, 2012 [3 favorites]


Plus, breast milk is free. Rather important if you're poor.

Free at the point of care, sure, but there are opportunity costs for breast feeding too, especially for women in jobs where it's hard to find pauses to pump or breast feed.
posted by MartinWisse at 6:59 AM on July 31, 2012 [10 favorites]


If this really happens, I'll be going across the river to have any children.
posted by roomthreeseventeen at 7:03 AM on July 31, 2012 [1 favorite]


I'm def in "We need to improve the terms of maternal leave and force employers to allow mothers accommodation to allow breast feeding" - but those numbers I was quoting were "Breastfeeding from initiation". If the theory that the need to work and lack of maternal leave for poorer people was what was driving those differences you would see the poorer and less educated cohorts drop breastfeeding at the 6 month and 12 month at a much faster rate than the other cohorts, but that actually isn't the case. by the 12 month the gap between Undergrad and High School has actually shrunk.

Many women who use formula do so for reasons other than raw ignorance, including many of the aforementioned one-third of women who have Caesarians

I actually don't think the data bears this out.
posted by JPD at 7:10 AM on July 31, 2012


I'm down with Bloomie on the transfats, soda, and cigs, but the formula thing angers me. Folks with HIV might have trouble breastfeeding. An anti-formula campaign would fuck with their heads as well as making things tougher to feed their child.
posted by angrycat at 7:10 AM on July 31, 2012 [1 favorite]


Many women who use formula do so for reasons other than raw ignorance, including many of the aforementioned one-third of women who have Caesarians

I actually don't think the data bears this out.
posted by JPD at 10:10 AM on July 31 [+] [!]


Given that "many" is a notorious weasel word that can be true with virtually any result, I think you'd be pretty hard pressed to show raw ignorance is the sole meaningful cause of formula use.
posted by gerryblog at 7:17 AM on July 31, 2012


Yes that's precisely why its a ridiculous thing to say. There is a reason why public health policy uses data and statistical analysis.
posted by JPD at 7:21 AM on July 31, 2012


Speaking of data, the Skeptical OB has the breakdown of the data on the WIC initiative to encourage breastfeed.
posted by ThePinkSuperhero at 7:24 AM on July 31, 2012 [5 favorites]


Any public health policy, however data-based, has to deal with the variation in individual experiences; you don't just roll up a one-size-fits-all policy for 50.1% of the population and call it a day. Universal vaccination programs allow for kids who are immunocompromised or have adverse reactions; we don't assert (without evidence, ahem) that statistically speaking they're just ignorant of the benefits.
posted by gerryblog at 7:27 AM on July 31, 2012


Any public health policy, however data-based, has to deal with the variation in individual experiences; you don't just roll up a one-size-fits-all policy for 50.1% of the population and call it a day. Universal vaccination programs allow for kids who are immunocompromised or have adverse reactions; we don't assert (without evidence, ahem) that statistically speaking they're just ignorant of the benefits.

Banning formula be would doing that. Removing free formula and prompting woman to consider breastfeeding one more time is not doing that. The vaccination example is a really poorly chosen given the number of truly immunocompromised children or those who will have an adverse reaction is really quite small.

Also its not 50.1% of the population. I mean for chrissakes - 73% of the population breast feeds already.
posted by JPD at 7:35 AM on July 31, 2012


Plus, breast milk is free. Rather important if you're poor.

Breastmilk isn't free. You often need accessories and you always need time. Women's time isn't free. You also have to feed us (I know, I know, so demanding!)

If the theory that the need to work and lack of maternal leave for poorer people was what was driving those differences you would see the poorer and less educated cohorts drop breastfeeding at the 6 month and 12 month at a much faster rate than the other cohorts, but that actually isn't the case. by the 12 month the gap between Undergrad and High School has actually shrunk.

Perhaps poor women are realistically assessing their ability to continue breastfeeding and deciding against initiating it because of the downsides of initiating and then stopping.
posted by the young rope-rider at 7:37 AM on July 31, 2012 [9 favorites]


I'll be sorry so see him my toddler now. And when will I surf metafilter when not nursing?

My kid breastfed until almost 4. My wife felt that she should let the kid decide when to stop, but she (wife) got seriously anemic and had to stop. She informed the kid that this was her last feeding, and cried through it. The daughter took it great, and was fine.

But, at times, I thought that my wife was going to fling the kid off her chest, out of the sense of boredom and confinement.

And it was sort of cute to have the daughter, randomly in any sort of situation, blurt out, "I still nurse," in front of strangers.
posted by Danf at 7:38 AM on July 31, 2012 [1 favorite]


Oh good, and here I was worried that I would manage to go all morning without being filled with rage. You know, there is a big difference between regulating something that is NEVER necessary vs. regulating something that is OFTEN necessary. And the sad truth is that formula is very often necessary. And now we are letting an overzealous breastfeeding-only frenzy make it harder than it already is for people to care for their children. I promise you this policy will lead to instances of undernourished babies.

My first child had horrible problems breastfeeding. She didn't like to latch. She would latch, but then she'd just fall asleep at the nipple. She was always hungry, but when she got even a little food she was just too tired to continue. And my wife wasn't the best cow. A lot of moms aren't. Which is another thing that successful pumpers don't take into account. While some women have no trouble pumping, others simply dry up because they don't respond well to the machine or they aren't allowed enough time at work. Anyway, when we went to the doctor for our first child's one month checkup, she was exactly the same as her birth weight. So of course the doctor gave us formula, and we started supplementing with that. A month later, she was up to weight and there were no problems. A simple problem with a simple solution.

But how does this story play out in the middle of this campaign of disinformation? And yes, frankly, it mostly is disinformation. There are good reasons to breastfeed, if ALL other things are equal, but most of the breastfeeding-only arguments about the sanctity of the suck and the dangers of formula are just so much feel good bullshit. Pediatricians know this, which is why they drop the breastfeed-only act the second it becomes clear that there actually are complications. And how does this story play out with women who have limited access to healthcare after their initial hospital visit?

If you don't want hospitals giving out free schwag to patients, then fine. But this One True Way bullshit is going to far, and we are fast approaching the point where we are going to hurt children with it.
posted by NathanBoy at 7:42 AM on July 31, 2012 [8 favorites]


When you get down to it, the policy seems to be moving formula from a free goody-bag item to something treated more like any other medical product, that has to be indicated before it's used. That doesn't seem unreasonable to me.

The mandatory lecture seems overwrought, but the general idea of not just casually handing a questionable (from a public health perspective) product out seems like a good idea. When a hospital is just tossing something in a goody bag and handing it out, it really seems to imply that it's perfectly safe.

I'm not sure what other products are treated similarly. You can probably come up with a very similar argument for strongly discouraging hospitals from sending people home with tons of high-dose acetaminophen, when ibuprofen or aspirin or some other less-toxic painkiller would work just as well. And a similar restriction would seem reasonable.

Seems suspiciously like the article was written by someone who hates Bloomberg and wouldn't like it if he was making it illegal to eat kittens, though.
posted by Kadin2048 at 7:46 AM on July 31, 2012 [1 favorite]


gerryblog: "Any public health policy, however data-based, has to deal with the variation in individual experiences; "

To an extent this one does, at least in that it mentions contraindications from a medical perspective. From the FAQ:
What are the medical contraindications to breastfeeding infants and/or mothers?

It is important to note that there are no contraindications to breastfeeding for the majority of healthy infants. However, there are some contraindications for infants and mothers:
• An infant diagnosed with galactosemia, a rare genetic metabolic disorder
• Some infants with developmental disabilities and birth defects
• Low blood glucose, while a potential contraindication for late preterm, small for gestational age, large for gestational age and infants of diabetic mothers, hypoglycemia is rarely a contraindication for breastfeeding healthy term newborns after normal pregnancy and delivery
• The infant whose mother has been infected with the human immunodeficiency virus (HIV)
• Is taking antiretroviral medications
• Has untreated, active tuberculosis
• Is infected with human T-cell lymphotropic virus type I or type II
• Is using or is dependent upon an illicit drug
• Is taking prescribed cancer chemotherapy agents, such as antimetabolites that interfere with DNA replication and cell division
• Is undergoing radiation therapies; however, such nuclear medicine therapies require only a temporary interruption in breastfeeding

Source: http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html
It doesn't take into account many other factors. But there is at least some acknowledgement that breastfeeding cannot be universally applied.
posted by zarq at 7:48 AM on July 31, 2012 [1 favorite]


The vaccination example is a really poorly chosen given the number of truly immunocompromised children or those who will have an adverse reaction is really quite small.

I know that. That's why I chose it. Your (unevidenced) claim supporting the policy was that it's good because most women who use formula do so simply because they are ignorant. That's much more true of vaccination than it is of breastfeeding, and yet a policy that forced or bullied immunocompromised kids into being vaccinated anyway on the grounds that from a statistical point of view they are probably just ignorant would obviously be a mistake.

re contraindications, I was thinking more about many women's need to supplement for perfectly acceptable reasons than about contraindication.
posted by gerryblog at 7:56 AM on July 31, 2012


Though I'm glad that language is in there, obviously!
posted by gerryblog at 7:57 AM on July 31, 2012


> The lecture-every-time thing is ridiculous, though. It's like Bloomberg thought "this law is too reasonable. I have to add something that people can fight about."

It's fair and balanced, see. By lessening the commercial influence by formula-makers, he's impeding their god-given rights to capitalism. But if there are mandated lectures to new mothers and bureaucratic obstacles to common sense...well, that that sort of paternalism makes it a lot more palatable.
posted by desuetude at 7:58 AM on July 31, 2012


By the way, I purposefully gave birth at a Baby Friendly hospital because I do believe that the attitude of nurses and staff can affect breastfeeding success. When I read that now I want to roll my eyes and LOL at some of the "benefits". Some of them are straight-up lies, like "breast milk is free" or really iffy research reported as solid fact like this: "Research also shows that breastfed babies have higher IQ scores, as well as better brain and nervous system development."

Then there are the blatant attempts at guilting the mother into doing what's best for a community that can't even bother to give her decent maternity leave: "Resources used to feed those in need can be stretched further when mothers choose to give their babies the gift of their own milk rather than a costly artificial substitute." Yeah, those resources can't be stretched far enough to allow women to spend time at home with their own baby if they could be working at McDonald's for the lowest minimum wage in the country.

And when it gets down to it, that's what pisses me off the most about this stupid bullshit. The sheer hypocrisy. Help the environment! Make you and your baby less of a burden on society! Your time is completely valueless! GIVE GIVE GIVE GIVE GIVE. Fuck you. The poorest women in society already give more than their fair share of labor and get fuck-all back.
posted by the young rope-rider at 8:08 AM on July 31, 2012 [24 favorites]


When a hospital is just tossing something in a goody bag and handing it out, it really seems to imply that it's perfectly safe.

In a city with a safe and plentiful water supply, formula is perfectly safe. Formula goody bags are shitty for other reasons, but it's not because formula is dangerous in any way.
posted by the young rope-rider at 8:10 AM on July 31, 2012 [1 favorite]


Some of them are straight-up lies, like "breast milk is free"

All along I was thinking that the single argument that might have tipped the scales towards me breastfeeding my kid was one of economics. Had I known how often he would eat, and figured out how much money it ultimately cost to feed him formula, I would have more seriously considered breastfeeding. So I'm surprised to see you say this is a lie, the young rope-rider. Why do you say it isn't free? Not disputing you, just wondering what angle I didn't consider.

That sounds extremely cold and calculating, but then I am a cold-hearted bitch.
posted by lyssabee at 8:23 AM on July 31, 2012


Why do you say it isn't free? Not disputing you, just wondering what angle I didn't consider.

When you can't go to work because your workplace is not conducive to breastfeeding/pumping, breast milk costs a lot.
posted by Rock Steady at 8:30 AM on July 31, 2012 [4 favorites]


There is definite research suggesting that breastfeeding does support a slight advantage in cognitive development over formula feeding but it's also quite possible that there are confounding factors that have not been accounted for in terms of diet and nutrition as well as other environmental factors. Of course measuring cognitive development in general has all sorts of issues due to disagreements about the tools for measuring such things.

There does seem to be a significant amount of research suggesting a link breastfeeding and improved immunological function vis a vis common childhood ailments.

On the other hand I definitely agree that breast feeding has a massive opportunity cost for many mothers. Most working mothers don't have a ton of maternity leave, many employers are not supportive of breastfeeding mothers in terms of pumping on the job, pumps in general tend to have a pretty significant upfront cost, etc.

Factor in the societal pressure both from external sources (parents, family, friends) and sometimes the partner (some partners feel excluded by the act of breastfeeding plus the inherent loss of time) and it's small wonder that the percentage of mothers that breastfeed one or more years is really really low.

Is breastfeeding a major concern for public health policy? I'm not sure, there are definite societal advantages for increased breastfeeding but on the other hand many of these same effects can be achieved by the market pressures of wanting to conform to the baby friendly certification.

As for individual implementation of guidelines, that's always a tricky subject because front line workers (nurses, lactation consultants) always have a degree of discretion in how they implement these types of guidelines. Some caregivers are likely to be quite understanding of the specifics of a situation and retain a good degree of flexibility whereas others might focus on delivering a black and white message and function as gatekeepers. It's always a challenge in any organization to ensure a cohesive but flexible set of policies.
posted by vuron at 8:41 AM on July 31, 2012


Haven't had a chance to read the whole thread yet, but wanted to address this:

As it stands, I suspect this is already the policy in Canada. When our first was born at BC Women's Hospital and we had problems feeding, we we offered donated breast milk rather than formula - and we were very grateful for it

It varies VERY much by province, by hospital, and even by the nurse that you have.

We're in Ontario (Oakville). My wife struggled to breastfeed with our firstborn, and we topped him up with formula because he was super jaundiced and her milk didn't really come in (and he never did end up latching properly, despite her trying for months). My wife was SUPER emotional and frantic that she wasn't able to feed our baby. The nurse we had wasn't at ALL judgmental about offering formula (the little pre-mixed 2 oz Enfamil A+ bottles that you just attach a nipple to). With our second born, same hospital, one nurse was very much of the "it doesn't matter if you haven't slept in 30 hours, are a complete train wreck, and your nipples are cracked and bleeding, your baby is hungry and you must try again breastfeed her" variety. When she went off shift, the next nurse said "You poor thing, why did [the last nurse] torture you like this? Just give the baby a top up of formula, it's not going to kill her, and you can try breastfeeding again once your nipples heal up a bit and you actually get a bit of sleep" - and guess what? Once her nipples healed, she was able to get the baby latching and she's still breastfeeding her (almost, we use powdered formula and sterile water on occasions where bottled breastmilk won't last long enough) exclusively at 4 months old.

That was our experience, but I have a feeling that everybody's hospital experience is going to be different depending on your nurses' views on breastfeeding.
posted by antifuse at 8:43 AM on July 31, 2012


And yes, the multiple comments from people about shaming women who are struggling to breastfeed, or decide NOT to breastfeed for whatever reason they want, are right on the money. We experienced that from multiple sources, women (and men!) looking down on my wife because she wasn't able to breastfeed our firstborn (he just was NOT able to latch). Once her milk came in, she pumped and bottle fed him the breast milk. But still people frowned at her whenever they saw her feeding him with a bottle.
posted by antifuse at 8:50 AM on July 31, 2012


lyssabee: "Why do you say it isn't free?"

Everyone's situation is different. At one point I made the following off the cuff calculations. Now keep in mind that we weren't breastfeeding, but pumping to bottles.

Months 1-2:
* Cost of breastmilk itself: free.
* Cost of breast pump: $0 to us. We were loaned a $300 model by a family member.
* Cost of wife pumping every few hours: High. emotional exhaustion, additional work stress. She was lucky enough to have a job that, while it didn't give her a ton of maternity leave, allowed her time and privacy to pump. Not everyone has that option. Stress and lack of sleep (high to begin with, with twins) was somewhat meliorated by me being able to feed the kids and give her time to rest. If you're breastfeeding newborn twins rather than pumping, that doesn't leave much time for sleep, to say nothing of work.
* Cost of special freezer bags to hold expressed milk: $15 bucks per week / Say, $100-$120 for 2 months.

Months 3-4
* Cost of having wife pump every few hours: Horrific. Because my kids' needs outpaced her milk supply. And she felt horribly guilty about it. And went to the doctor to try and help her keep up with demand.
* Cost of fenugreek tea: $4.00 for a box. We probably brought a box or three.
* Cost of dark beer: $10/$12 for 6. We probably bought and went through a few cases.
* Cost of doctor's visits to diagnose issue and suggest help: $200. Maybe more.
* Cost of prescription medication to help increase milk supply: $0. Because we decided that it was simply not worth that, and we wanted to try and relieve her stress.

Months 5-13:
Cost of cans of formula: $120 per month / average
Having a wife who can sleep through the night, doesn't (wrongly) feel like a bad/inadequate mother and isn't wracked with guilt: Priceless.

I used to joke that I'd save money if I switched the kids to unleaded. But looking back we should have switched to formula immediately around month 3. Would have saved my wife a lot of anguish.
posted by zarq at 8:51 AM on July 31, 2012 [9 favorites]


That's the thing about these studies -- they all show that all other things being equal it's better to breastfeed than to formula feed. There's no disputing that. But in the real world, all things are rarely equal. Each option has different costs and benefits and each family has to come to a decision that depends on their own individual situation. As zarq says above, does the ability of the mother to sleep through the night count for nothing? Surely, even for the baby, it's better to have a happy, guiltless, not-so-anxious mother rather than one who's trying to juggle a hundred things at once and feeling like a failure? What the government should be trying to do is to institute policies that would lead more families to do the calculus and come out on the breastfeeding side, because it makes more sense and is doable for them.
posted by peacheater at 8:59 AM on July 31, 2012 [7 favorites]


I gave birth six years ago in a hospital that does exactly this. No free formula, no giving babies formula without permission, Mom has to speak with a lactation consultant before the nurses will give her baby formula. In practice, the "talk with the lactation consultant" was, in at least one case, a pure formality; the LC came in and said "I hear you need to give your baby a bottle?" and Mom said "Yeah, I'm bipolar and my meds --" and the LC said "Yup, I already saw it in your chart, we'll send it right up." When my nipples were starting to crack, the nurses told my husband what kind of hydrogel pads to get to solve the problem, rather than telling me to just give her a bottle while they healed.

My daughter appeared to drop an alarming amount of weight, but it was kind of an illusion; she was born very waterlogged, and peed off 9 oz of fluid in 12 ounces. They were so startled at the weight loss that they actually went and got the original scale to make sure there wasn't a scale error, and then looked up the calibration logs to make sure the scale had been properly calibrated. She only lost two more ounces after discharge, and by the time she was 3 days old, had gained it back and then some, but STILL, even at this baby-friendly anti-formula hospital, the well-baby nurse freaked out over her "weight loss" and insisted I supplement between feedings. "Can I supplement with pumped breastmilk?" I asked in tears, and she sniffed "Well, I GUESS." My husband and I both left that appointment sobbing. (We did not supplement with formula, after talking it over with my pediatrician. She was gaining an ounce and a half a day on breastmilk alone. The pediatrician pronounced the well-baby nurse's advice "horseshit.")

A friend of mine's sister gave birth in a more rural hospital, and told the nurse that she wanted to breastfeed her daughter. They said OK, but when the nurse brought her to her in the recovery room, she was already sucking on a bottle of formula! She said "Oh, I wanted to breastfeed" and they said "Oh, honey, that usually doesn't work out." My friend arrived, FREAKED OUT, and asked to speak to a lactation consultant; "Oh, we're all lactation consultants!" was the answer. When none of the nurses even knew what a football hold was, she inquired as to whether they were IBCLCs, and it turned out that, no, they had gone through Enfamil's "lactation consultancy" seminar. The one put on by the formula company. My friend threw all the nurses out of her sister's room, and taught her sister how to breastfeed her baby, and it worked like a charm.

There is a lot of pro-formula bias within the hospital culture, even now, and that's what this voluntary policy sounds like it is designed to correct. But the other half of the equation is that our culture is, as noted above, incredibly mother-hostile; our pumping rights laws are horrific, our maternity leave policies are worse. If a woman has to go back to work when her baby is two weeks old because, well, she needs to pay her bills, and if that job is a retail or food service job (as so many are), pumping may well be logistically impossible for her, even if it's technically allowed.

Brand-new mothers get very little support in our culture; their partners may not be fully and enthusiastically on board with stepping up to assist, and even if they are, they still have to go to work to pay the bills. When my first child was born? My husband took 6 weeks of paternity leave, my mother (who is a La Leche League Leader) stayed with us for two weeks, my father-in-law bought us a month's worth of frozen dinners, and I was on a street full of stay-at-home-moms who came by literally every day to provide some social contact and fold laundry and wash the dishes. That (plus the fact that I make plenty of milk) made breastfeeding very easy for me, once I got through the first hellish week.

In theory, I am totally in favor of this policy. Certainly, situations like the one my friend's sister gave birth into need to change, and pronto. But until every mother has the kind of support I did, demands and lectures and shaming about breastfeeding are merely going to take yet another portion out of new mothers, who are already stretched to the breaking point. Formula is not poison; it is not as good as breastmilk, but it is definitely OK, and plenty of kids thrive on it. New mothers are victims of the machine, not the agents of it.
posted by KathrynT at 9:07 AM on July 31, 2012 [11 favorites]


Ha, well, I gave birth in NY and I can tell you (as I found out later) their C-section rate is pretty damn high, and c-sections are one of the main reasons women can't/aren't up to breastfeeding. The formula pushing doesn't help, but it would be nice if Bloomberg et al looked at some other factors affecting breastfeeding also. Is he going to mandate lactation consultants who aren't just one to a hospital and work outside of 8-5 Monday through Friday? Because that's one of the reasons I couldn't get any help with my kid, aside from the surgical recovery and my kid being kept away from me for four hours post-surgery despite my constant begging to see him/feed him. He was fed formula w/out my consent because he was starving, because they wouldn't let me see him.

Oh and the surgeon did a crap job, left tissue inside me, so my milk never came in. At all. And then I hemorrhaged 10 days postpartum, but by then, I was too tired to try breastfeeding anymore because I had already gone through hell.
posted by emjaybee at 9:13 AM on July 31, 2012 [1 favorite]


So I'm surprised to see you say this is a lie, the young rope-rider. Why do you say it isn't free? Not disputing you, just wondering what angle I didn't consider.

Even as a stay-at-home-parent (which is not free either, but let's assume that it is) needs more food in order to breastfeed an infant. Our grocery bill is hilariously cheap now that we're feeding formula. Some of the calories for the baby come from maternal fat stores, and I did lose weight in the first two months, but at a certain point my body was like "nope, let's hang on to those 'maternal fat stores' because hell there's food everywhere why not" and I was making breastmilk solely from extra calories going in and was ravenously hungry 24/7.
posted by the young rope-rider at 9:25 AM on July 31, 2012 [2 favorites]



There is a 20 point gap in breastfeeding rates between mothers with a High School Diploma or less and mothers with an Undergraduate degree.

There is a 30 point in between mothers 30+ and 20 years of age.

African-Americans breastfeed at a rate 20 points below the rest of the United States.


Underlying this common discourse - which aims to root itself in facts - is the deep-seated cultural assumption that poor people, especially poor brown people, are stupid. That's why the solution is always lectures and lock-downs, and why the solution is always imposed from above by much richer and usually whiter people. And that's why the "solution" usually fails, or just creates a boatload of new problems.

If I were in charge, I'd look closely at the breast-is-best research, for starters - I've seen some material that suggests that the differences are not actually as strong and persistent as claimed, and I'd like to know just how much of a panic-stations issue this really is. Then, assuming that it really was the best use of health-care dollars to heavily push breast-feeding (rather than deal with the many other crying needs), I'd convene a bunch of working groups of mothers with an emphasis on working class women and women of color. What do they do? Why do they do it? What would they suggest? If education is involved, what kind of education is likely to be the most effective and the least patronizing? I'd develop a program based on the fucking needs of the population, assuming that those people are as smart as anyone else and as worthy of respect.

Of course that will never happen because it's much better for middle class and white people to generate jobs, publicity and political power for themselves by regulating and shaming working class people - especially if the regulations fail, because that's just proof of how intractable, stupid and untermenschen those people really are.

I'm beginning to think that we should replace 'white people problems' with 'white people solutions'....a phrase to be used when we turn structural problems into moral panics, impose top-down 'solutions' and then, for preference, generate new problems that are individualized rather than social.
posted by Frowner at 9:36 AM on July 31, 2012 [24 favorites]



The medical evidence supporting breastfeeding instead of formula feeding is pretty significant.

I don't really think it is. Most of that evidence does not take into account any of the thousands of other factors that go into a newborn's development.
posted by roomthreeseventeen at 9:40 AM on July 31, 2012 [4 favorites]


I don't understand why this is about "personal choice." Society has an interest in babies being as smart and healthy as possible.
posted by 1adam12 at 3:26 AM on July 31 [2 favorites +] [!]


Okay dude, my baby is due December 1. I assume you and society will be at my place starting on the 2nd of the month to take shifts changing diapers, burping the child, reading to her, playing with her, and so on all the way to her 18th birthday?

No? You're not going to be hands-on about helping me raise my daughter? Okay, then you can (expletive suppressed in the name of civility).

Society's interest in my child can overlap with society's participation in raising the child. As far as making reasonable decisions about my baby's health, well, me and my wife can handle that.

KTHXBYE.
posted by ben242 at 9:44 AM on July 31, 2012 [12 favorites]


Ever since HIV/AIDS, you here a lot less about milk banks. There are risks with other people's milk.

Animal milk is a bit risky, TB, listeria, e.coli, formula is actually somewhat less risky if you don't have milk, or can't nurse.
posted by Katjusa Roquette at 9:47 AM on July 31, 2012


I have read some early-stage research about the reasons for racial differences in breastfeeding. There are complex cultural factors at work, particularly around the appallingly recent history of coerced wet-nursing, that influence women of color's decisions to choose formula for their own babies.

Even I, a pretty dyed-in-the-wool breastfeeding activist, am not going to be all Nice White Lady about breastfeeding under circumstances like that. Any efforts to increase breastfeeding rates among women of color that don't take cultural factors into account -- to say nothing of economic factors -- are doomed to be ignored, at best.
posted by KathrynT at 9:49 AM on July 31, 2012 [5 favorites]


I like everything about this except the mandated talk part. The mandated talk part is stupid.

But you know what would be better? Requiring all hospitals to have LCs on 24 hours and for all new mothers to be provided support with a lactation consultant for 12 weeks instead of the usual 6 given by insurance.

And again, parental leave for ALL! More time off benefits for women = more time to learn and establish breastfeeding.

I don't think formula is the devil -- my daughter has some at daycare since I don't get much from the pump, at home she nurses --- but I do think that nurses and doctors are inadequately trained on breastfeeding and lactation consultants are severely underused and underrated.
posted by zizzle at 9:57 AM on July 31, 2012 [1 favorite]


Requiring all hospitals to have LCs on 24 hours and for all new mothers to be provided support with a lactation consultant for 12 weeks instead of the usual 6 given by insurance.

Oh yeah, that's the other thing. The hospital I gave birth at? Offered free LC support, 24/7, for a YEAR. That's the kind of institutional change that is necessary, and that will really affect long-term breastfeeding rates.
posted by KathrynT at 10:08 AM on July 31, 2012


It seems like the problem is more with shitty lactation consultants than it is with this policy. For LC's that really know what they're doing, base their advice on good research, are respectful, and professional, I don't think there will be any problems.

I have a lot of nervousness in general around Mrs. VTX and I trying to have children. One of my greatest fears around the (eventual) birth itself is having to deal with shitty healthcare professionals and LC's specifically. It seems like every woman I know who have given birth have had an awful experience with lactation consultants (echoing many of the horror stories here). Anecdata or not, there are too many people in the profession who are just terrible.

My concern is that we'll get an LC who will make my wife cry and feel horrible. Knowing what I know about myself, I'll likely go into, "GRAH, PROTECT THE FAMILY" caveman mode and hit the LC with the nearest club.
posted by VTX at 10:40 AM on July 31, 2012


I spent a lot of time composing this, trying to make sure that there was as little hyperbole and bias as possible -- no easy feat considering the topic and emotions involved.

People in the U.S. are in an odd position regarding this topic due to the overwhelming force with which formula companies peddle their products. This discussion has plenty of links to review, particularly the WHO's International Code of Marketing Breast-Milk Substitutes (summary) adopted in 1981 which, for some crazy reason, the U.S. continues to pretend doesn't exist.

The way our society and culture deal with this question is so far out of line with the rest of the world that it is indeed a very difficult topic to discuss.
posted by odinsdream at 10:41 AM on July 31, 2012 [1 favorite]


I hate people who think they should have a right to dictate what other people do with their bodies. I really, really hate them. I'd like to make them sit in a smoke-filled bar for six months and feed them nothing but cheap whisky and bad burgers. Just so they'd know how it feels to have some rancid, self-important ass telling you how to live.
posted by Decani at 10:42 AM on July 31, 2012


From the code:
Article 5. The general public and mothers
5.1 There should be no advertising or other form of promotion to the general public
of products within the scope of this Code.
5.2 Manufacturers and distributors should not provide, directly or indirectly, to
pregnant women, mothers or members of their families, samples of products within
the scope of this Code.
That single bit departs so significantly from how most people interact with manufacturers of breast-milk in the U.S. that you'd probably have trouble convincing people you didn't flat-out make it up. Much less that the WHO has been recommending this for over three decades.
posted by odinsdream at 10:44 AM on July 31, 2012 [1 favorite]


...manufacturers of formula, not breast-milk...
posted by odinsdream at 10:45 AM on July 31, 2012


Oh yeah, that's the other thing. The hospital I gave birth at? Offered free LC support, 24/7, for a YEAR. That's the kind of institutional change that is necessary, and that will really affect long-term breastfeeding rates.

That single bit departs so significantly from how most people interact with manufacturers of breast-milk in the U.S. that you'd probably have trouble convincing people you didn't flat-out make it up. Much less that the WHO has been recommending this for over three decades.

I'm going to go out on a limb here and say here that the single thing that might make way more difference than all of this, is forcing all employers to provide a long period of fully paid maternity leave for *all* women in the US. Plus providing free equipment and medical supplies/care for any issues that might arise from breast feeding. You can stop people handing out free formula, lecture people up the wazoo, provide all the lactation consultants you like but it's not going to make a bit of difference if you're working in a shop somewhere and can't leave your till to pump or if you have to go back to work quickly because you need the money. And as we're currently living in a world where leaving some positions to pee or change a tampon, I don't see the world of many working women making it easy to breastfeed soon.
posted by lesbiassparrow at 11:10 AM on July 31, 2012 [15 favorites]


lesbiasparrow, if I could favorite that a thousand times I would. From your mouth to God's ear.
posted by KathrynT at 11:13 AM on July 31, 2012


"And as we're currently living in a world where leaving some positions to pee or change a tampon" should read "And as we're currently living in a world where leaving some positions to pee or change a tampon *is frowned upon*."
posted by lesbiassparrow at 11:16 AM on July 31, 2012


lesbiassparrow, some women don't wait to take extra time off of work. Some women don't want to breast feed. It's not a big deal.
posted by roomthreeseventeen at 11:19 AM on July 31, 2012


lesbiassparrow, some women don't wait to take extra time off of work. Some women don't want to breast feed. It's not a big deal.

Excuse me, who made you the arbiter of what's a big deal or not? I think it's a fucking big deal that the US still has these insane maternity leave policies and provides so little support for people who do indeed want to continue working after giving birth, and I bet there are lots of people here who agree with me. Framing it as a matter of personal choice -- some people want to do this, some people want to do that -- is doing us all a dis-service.
posted by peacheater at 11:24 AM on July 31, 2012 [2 favorites]


peacheater, I meant I don't think anyone should care if a woman, fully educated about her options, chooses differently than you want her to for her child. Not a big deal.
posted by roomthreeseventeen at 11:28 AM on July 31, 2012


lesbiassparrow, some women don't wait to take extra time off of work. Some women don't want to breast feed. It's not a big deal.

And that's great for them. But as it stands essentially only women in certain jobs and social classes in the US get those choices. What poor women get are a pile of lectures about how they are Doing it Wrong. Apparently there's an inexhaustible free supply of those.
posted by lesbiassparrow at 11:30 AM on July 31, 2012 [7 favorites]


If she's fully educated and not coerced by external factors, including shitty maternity leave policies and economic pressures, then it's not a big deal. But the fact that a large percentage of women ARE coerced by those external factors IS a big deal -- a big, horrible deal. Those women need support, not shaming or brushoff.
posted by KathrynT at 11:32 AM on July 31, 2012 [6 favorites]


Look at JPD's comments above about the differences in breastfeeding rates for different socioeconomic indicators and then tell me that simply a matter of choice rather than limited options.
posted by VTX at 11:40 AM on July 31, 2012


The medical evidence supporting breastfeeding instead of formula feeding is pretty significant.

I don't really think it is. Most of that evidence does not take into account any of the thousands of other factors that go into a newborn's development.


...are all those thousands of factors medical?

I dunno, it seems like that argument about how smoking can't really be bad for you because I know a guy who smoked his entire life and never got lung cancer, and I know another guy that never smoked and he got lung cancer, so how bad could smoking be for you medically when there are all these other factors?!

Taking into account the simple immunity and human-specific growth factors found in milk but not formula, it's pretty freakin important medically. Is it the only thing ever that can keep a baby alive? No - but no one's saying that.

Is there a downside to breastfeeding when mothers have to go back to work? Yes. But this is a social side effect of breastfeeding, not medical. Every woman needs to make her own choice in that - shame-free. But, as said above, simply stating medical facts should not be considered "shaming"

And is there a medical downside to using formula when the mother is unable to produce milk? Of course not - because now the other side of the equation is not breast milk, it's starvation.
posted by Lt. Bunny Wigglesworth at 11:40 AM on July 31, 2012


I just want to add to this discussion that I have both formula fed a baby and breastfed a baby.

I didn't find one to be any easier than the other. When I formula fed my son, there were bottles to be washed, an extra thousand dollars a year we didn't have to spend on formula, and a lot of difficulty in finding a formula that didn't upset his insides so much that he spit it all up. Getting up to mix a bottle in the middle of the night sucked a lot. But on the plus side, my husband could take over some of those night feedings for me.

With my daughter, who is mostly breastfed, there are three bottles to wash and only on weekdays. But I don't respond well to the pump, so when I'm not working, I have to be available to her. I eat a lot more food, though now that she's tapering, I'm not eating so much all the time but our grocery bill has gone up some --- probably not as much as the cost of formula, but some. It's far more difficult for me to get out and about without my daughter because she is breastfed and because I don't respond to the pump and because she DOESN'T take the bottle at home --- only at daycare.

But on the plus side, I don't have to worry about whether I've brought enough formula or water for her when we do go out, and I don't have to listen to her get upset while I'm trying to mix a bottle as I did with my son because the boob just goes right into her mouth. I get a lot more sleep because I don't have to fully wake up to mix a bottle.

So from my perspective of having done both, feeding a child is work no matter what. Being a parent is work no matter what. Formula feeding and breastfeeding are both really hard. But the challenges are different.

And I definitely prefer the challenges of breastfeeding to the challenges of formula feeding, especially the really real prohibitive cost challenge --- formula is so effing expensive it's a crime.
posted by zizzle at 11:49 AM on July 31, 2012 [10 favorites]


if you're working in a shop somewhere and can't leave your till to pump or if you have to go back to work quickly because you need the money. And as we're currently living in a world where leaving some positions to pee or change a tampon, I don't see the world of many working women making it easy to breastfeed soon.

Obama did require employers to allow women to pump at work. The breaks are unpaid, but I never got any paid breaks, so I don't see anything wrong with that.

I wonder if we might see a change in perceptions if more women actually took employers up on these benefits instead of just going to formula.

I have two friends that are new mothers - both chose to go to formula because pumping at work would have been a pain. Due to the set up of one place, one would have had to essentially kick her boss out of his office. I wonder if enough women had had the nerve to do that instead of just going to formula if there wouldn't have been an idea to create a small private break room or something.

I do think we should get maternity leave....but I disagree a year at full pay - I don't think it's fair for an employer to have to pay for work they aren't getting - especially when a year's pay is so variable. For some it would be 15K, others 100K. I think new parents should get a stipend from the government, not the employer, if they choose to stay home.
posted by Lt. Bunny Wigglesworth at 11:54 AM on July 31, 2012


They're paying the employee for work their mother did years ago to raise her. The other way to look at it is that they're paying the new mother for the work of raising the child on behalf of whatever future company(s) ends up hiring that child.
posted by VTX at 12:08 PM on July 31, 2012


They're paying the employee for work their mother did years ago to raise her

What? Really? No. Are they going to pay childfree women for the work their mothers did?
posted by roomthreeseventeen at 12:11 PM on July 31, 2012 [3 favorites]


The point is that new mothers do lot of work that goes unpaid.

Are they going to pay childfree women for the work their mothers did?

They probably should. If it were up to me, I'd make maternity leave Federally funded.
posted by VTX at 12:16 PM on July 31, 2012


It seems like the problem is more with shitty lactation consultants than it is with this policy.

Reading this thread simultaneously makes me feel so sad for people who have encountered bad LCs and so freaking grateful for the one I consulted with both of my kids. I had all kinds of challenges but she was comforting and encouraging and made all the difference.

Anybody on the SF peninsula looking for an awesome angel of a Lactation Consultant, memail me.
posted by ambrosia at 12:19 PM on July 31, 2012


Obama did require employers to allow women to pump at work. The breaks are unpaid, but I never got any paid breaks, so I don't see anything wrong with that.

I don't know anything about this specific mandate, but I know I have had many jobs where, if I demanded all the rights accorded to me by law, my employment would have become a living Hell, and would probably have been terminated at the earliest opportunity.
posted by Rock Steady at 12:41 PM on July 31, 2012 [8 favorites]


I'm curious, Lt. Bunny Wigglesworth, and I'm honestly not snarking: Do you put this much energy into childhood hunger of children, say, two to ten years old? Because a child being formula fed isn't suffering actual brain damage, but children receiving inadequate nutrition ARE. There are a number -- an appallingly large number -- of children in my city, young children, kindergarteners, who receive ten meals a week: five federal breakfasts and five federal lunches. Nobody feeds them dinner, and on weekends they scrounge for what they can get. When we close school for snow days, those children don't eat.

So I wonder -- given that formula is totally nutritionally adequate and those infants are being fed perfectly adequately, but there are children wherever you are living in the U.S. right now who are literally starving, do you put this level of attention and energy into childhood starvation of children out of babyhood?

It's really hard for me to understand this level of "But breastfeeding is perfect, and formula is slightly less than perfect, and adequate childhood nutrition is in the government's clear interest!" when there are children actually starving who could do with some calories of almost ANY sort. I mean, there are children with clearly acute and immediate nutritional needs right now this second. If the rationale is that childhood nutrition is important, why is an infant's non-acute preference for breastmilk more important than older children's acute need for any calories at all? What makes the infant more important than the three-year-old?
posted by Eyebrows McGee at 12:51 PM on July 31, 2012 [13 favorites]


simply stating medical facts should not be considered "shaming"

Is there anybody here who's been saying that? I think I missed it. In all of my experience with breastfeeding nazis, as my wife and I refer to them, it's never been a simple case of "stating medical facts". There has always been shaming involved, ALWAYS. Usually in the form of some implication of "Well you're just not trying hard enough" or "Don't you want what's best for your child? That's what a good mother would want for their child". Or, even better, when the lactation consultants start busting out the condescending tone and using words like "sweetie" to refer to my wife, as in "Oh sweetie, you think this is hard now? This is NOTHING" - yeah, ya know what? F you, lady. This is not the right tone to be using with a woman who has just had a baby, is going on 2 hours sleep after a HUGELY emotionally and physically draining experience, and is flooded with post-partum hormones. I really, HONESTLY wonder what kind of training these lactation consultants actually go through. Because sometimes it really feels like sensitivity training is a part that has been completely left out.
posted by antifuse at 1:00 PM on July 31, 2012 [3 favorites]


This crap drives me crazy. If you can breastfeed your kid, and you want to, great. If you want to breastfeed your kid and you don't have enough milk or the baby doesn't like your boobs (yes, it happens) or it HURTS (and sometimes it hurts REALLY BAD) then switch to formula and move on. If you don't want to breastfeed, then don't. I'm baffled as to why we need lactation consultants...why the fuck do women need consultants to tell them how to do things we've known how to do for thousands of years? I told those LaLeche bitches to get the hell out of my room.
posted by Kokopuff at 1:54 PM on July 31, 2012


From the wonderful satirical Twitter- Miguel Bloombito ‏@ElBloombito
Por favor not to give los babyados el formula. Necesito el leche de los boobos. Que whip it out!
posted by The Biggest Dreamer at 2:27 PM on July 31, 2012 [3 favorites]


Decision not to have children validated by this thread!
posted by josher71 at 2:55 PM on July 31, 2012 [1 favorite]


Kokopuff, the first time you have a baby you realize that neither you nor the baby has ever done this before...help and advice are needed.

I got the best advice from my first child's pediatrician who had me nurse at the very first appointment so she could show me what the proper latch was. I also had tons of breastfeeding friends for help and advice. Years later one of my daughters was able to get help from lactation consultants along with advice from me (grin) and was able to nurse successfully.

Just because women have done something for thousands of years doesn't mean they didn't need a bit of help and advice to start with.

That having been said, there is a million miles of difference between help and coercion. As much as I am totally of the belief that breast is best, for a particular individual it may NOT be best.

And fwiw back when I was born I and a whole lot of babies were fed formula made from evaporated milk and Karo syrup, with the doctors being the ones who gave our mothers the recipe. We lived. ;-)
posted by St. Alia of the Bunnies at 3:26 PM on July 31, 2012 [2 favorites]


I'm baffled as to why we need lactation consultants...why the fuck do women need consultants to tell them how to do things we've known how to do for thousands of years?

And for thousands of years, we have also had midwives/wise women/doulas/maias/baby catchers who attended the births of women and offered new mothers help, advice and assistance with their new children.
posted by jacquilynne at 3:32 PM on July 31, 2012 [3 favorites]


why the fuck do women need consultants to tell them how to do things we've known how to do for thousands of years?

Same reason we need consultants to tell people how to field dress a large animal / cook a meal / spin fiber into thread / run a race / anything else we've known how to do for thousands of years. If you've never seen it done before -- and for many women, the first time they have ever seen a newborn baby try to latch is the when they are doing it with their own child -- it helps to have an expert around to point out the tips and tricks.
posted by KathrynT at 3:49 PM on July 31, 2012 [2 favorites]


i had to watch my wife cry when she couldn't produce milk for my newborn daughter and listen to my daughter cry because she was hungry. if it wasn't for formula she wouldn't have made it.

fuck you, mayor bloomberg.
posted by lester at 8:44 PM on July 31, 2012


I'm not sure what other products are treated similarly. You can probably come up with a very similar argument for strongly discouraging hospitals from sending people home with tons of high-dose acetaminophen, when ibuprofen or aspirin or some other less-toxic painkiller would work just as well. And a similar restriction would seem reasonable.

Um, no, food is not drugs. There's no toxicity level for formula or breast milk. But you could come up with a similar argument for sending someone home from the hospital with a box of Honey Nut Cheerios for breakfast rather than bringing them a bowl of oatmeal and a glass of orange juice.
posted by desuetude at 10:14 PM on July 31, 2012


If a woman can't or won't breastfeed, why not send her home with formula? Do we really need to express our disapproval by forcing her to stop at a pharmacy while transporting a newborn baby?
posted by Joe in Australia at 3:52 AM on August 1, 2012


I'm baffled as to why we need lactation consultants...why the fuck do women need consultants to tell them how to do things we've known how to do for thousands of years? I told those LaLeche bitches to get the hell out of my room.

I can't tell from your comment if you've done this yourself. If you have, and it was a good experience without problems, that's wonderful. For plenty of other people, however, simple advice is enormously helpful. For instance, we had a very difficult time initially with maintaining a good latch without pain. After a week or so we visited a lactation consultant for help. This was literally the best $90 we've ever spent, because very tiny changes in positioning had enormous benefits, but without guidance we were never going to just find out independently which changes to make. After a good hour or so we were able to make it through an otherwise very difficult time over the next few months.

As jacquilynne just mentioned, a lot of the assistance that lactation consultants now provide is filling a void that exists because of a cultural shift towards parenting in isolation. The weirdest part about breastfeeding is the myth that it's an innate, natural skill.
posted by odinsdream at 5:45 AM on August 1, 2012


If a woman can't or won't breastfeed, why not send her home with formula? Do we really need to express our disapproval by forcing her to stop at a pharmacy while transporting a newborn baby?
posted by Joe in Australia at 6:52 AM on August 1 [+] [!]


Because it's a complete myth that breastfeeding is established in two days.

It's also a complete myth that milk comes in in two days.

With my son, my milk didn't come in properly, and I blame the nurses at the hospital for pushing formula. He wasn't hungry and starving. If they had helped me breastfeed instead of telling me to start supplementing, I probably could have breastfed him. But in my case, yes, I am 100% convinced that the formula did in fact ruin the breastfeeding relationship I could have had with him because after he had the formula he wouldn't nurse. Because he wouldn't nurse, my milk wouldn't come in. Milk comes in by a baby -- and yes, sometimes a hungry baby --- nursing like crazy for the first few days.

With my daughter, my milk came in on DAY 5!!! DAY 5!! Not day 2. Not day 3. DAY 5. I had colostrum for two days, then transitional milk for two days, and then...whoa, milk milk on Day 5. And she was fine.

When she was 3 days old, she refused to nurse. She was screaming her head off for close to an hour or two and refused to nurse. It was normal newborn disorganization. I could have given her formula, except we didn't have any. So frustrating as it was, I went through all the baby techniques I knew and hard it was to listen to her scream like that, I patiently worked and waited and did everything I could and by some miracle, she remembered where her food comes from and happily settled in for a good long nurse.

But I didn't know I needed to have that kind of patience with my son --- I was misinformed. A lot of the early days of breastfeeding is about patience, and giving formula before someone's milk comes can and does actually harm breastfeeding relationships. Maybe not everyone's, but as a general practice, it is. And I know, believe me, I know how hard it can be to have that patience. The only reason I made it through that night --- and a few other ones like it --- is because KathrynT is in a time zone three hours behind mine and would often be on gmail chat, so I'd talk to her about what was going on and she'd offer encouragement and support. If I had only had something like that in the early days of having had my son instead of, "Oh, hey, he needs some formula," things very likely could have been very different for us.
posted by zizzle at 6:03 AM on August 1, 2012 [3 favorites]


When I gave birth, my baby had to drink of course. I also had to drink, and water was pushed on me often. The nurses frequently asked if I was drinking enough, explained why it was important, and also asked my husband to make sure I had enough.

However, the water wasn't provided to me in my choice of cute Dasani® or Aquafina® tote bags with money-saving coupons and literature on why Dasani® or Aquafina® was the right choice for me.
posted by that's how you get ants at 7:19 AM on August 1, 2012 [3 favorites]


Also, I didn't use formula although latching was really difficult and we didn't figure it out in the hospital. Yes, my baby was hungry, and yes he did gain weight slower than formula-fed babies but I was glad that the hospital supported me and didn't push formula on me. We figured it out eventually, and he didn't have a drop of formula until he was six months old.

I know breastfeeding's not for everyone, and I don't care who uses formula and who doesn't, but there are still plenty of people out there who will say "That baby is starving! Give it some formula!" especially once you're out of the hospital. I think hearing "this might take a while, but it's okay and normal" at the hospital was a good thing.

Also also, mothers have known how to breastfeed for thousands of years, but let me tell you, newborn babies don't know shit.
posted by that's how you get ants at 7:27 AM on August 1, 2012 [1 favorite]


Precisely, that's how you get ants.

I've been a bit bewildered - and saddened - by the comments in this thread. I had my baby in a baby-friendly hospital here in the Netherlands, and for medical reasons he needed to have formula during the first week (he was sick, and frankly so was I after a post-partum haemorrhage). Formula is freely available, even in UN-certified baby-friendly hospitals. However, formula companies are not allowed to provide you with free samples and I was even given a questionnaire after leaving the hospital, asking questions such as whether I had been given any advertising material or samples of baby formula. The UN keeps an eye on this, as it is against the guidelines and if it happens it can lead to a hospital losing its baby-friendly status.

As someone who had to struggle to breastfeed my son after the blood loss issues, and made it with great support from the nursing staff, I am greatly sympathetic to how difficult it can be for some women. And you know what? As a feminist, I respect all women's decisions to do what is best for their own kids (and themselves). People are always surprised, if not shocked, when I say that I may not breastfeed my next child (or at least, maybe not for very long). It can be really really hard, and I'm just going to take it as it comes. I am a proud member of La Leche League and have found the support invaluable in the face of the active discouragement I got from the health authorities here.

My point in all of this is NOT that I am anti-formula in any way, shape or form. It is that I don't believe that commercial interests have a place in this discussion or in the decision to breastfeed and/or give formula. The nurses at the hospital were well-educated on exactly what my son needed given his and my poor health, and were also well-educated on exactly how to help me to build up my supply so I could give less and less formula with each feed. Formula is also available to women who choose not to breastfeed in a baby-friendly hospital. It's just that it is purchased by the hospital (just like the nappies are), not given by companies who are pushing their own products.
posted by rubbish bin night at 7:33 AM on August 1, 2012 [1 favorite]


I know breastfeeding's not for everyone, and I don't care who uses formula and who doesn't, but there are still plenty of people out there who will say "That baby is starving! Give it some formula!" especially once you're out of the hospital. I think hearing "this might take a while, but it's okay and normal" at the hospital was a good thing.

And there were, eleven-plus years ago, people out there who will made mothers who aren't able to breast feed feel like less of a woman and a mother. Clearly there is a wide range of breastfeeding education and experience out there, so maybe a blanket requirement applying to all hospitals and all mothers is not the best thing.
posted by Rock Steady at 8:05 AM on August 1, 2012


I stepped out of this thread yesterday without comment as I wanted to sit and think through what was being said and really think through what I wanted to say before opening my mouth and shoving my foot firmly down it.

I see more and more in US culture this drive towards the ideal rather than the real, and I see it as especially pervasive and insidious when it comes to issues that affect women disproportionally. I see this in arguments over birth control, abortion, childbirth, maternity/paternity leave and now formula.

By ideal, I mean that there exists a patent dismissal of the too-numerous-to-count biological, economical and sociological factors that are used in making a decision in regards to any one of the contentious issues above in favor of assuming the best case scenario. Using this framework, I'm a shitty, selfish mother for stopping breastfeeding at 12 weeks even though Toddler theBRKP was getting enough, barely. That I hadn't slept more than 2 hours at a stretch in 12 weeks - suck it up! That breastfeeding on one side was excruciating, even though he was latched correctly - suck it up! That I was spiraling even further into postpartum depression - feed your baby! It'll will release hormones that will make you feel better. Oh, and suck it up! My REAL experiences, my REAL feelings, my REAL perceptions were not as important as ensuring baby was not given "poison" in the form of formula in a bottle.

Compound the refusal to acknowledge that there are many variations other than "best case" with the absolutely, deeply entrenched attitude in US culture that we are individually responsible for the raising of our children, that [typeOf] individual shouldn't have to pay for another's maternity/paternity leave (or birth control, or ...[enterIssueHere]) and it is no wonder that a good number of us on pro-poison** side want to bang our heads into unconsciousness.

The real is that there are too-numerous-to-count biological, economical and sociological factors that play into a woman's/couple's decision on any of these issues. Dismissing those factors with a wave of the hand, the assumption that individuals are either stupid or not educated enough, and the statement "change your culture" is unrealistic, unsympathetic and patronizing to every single woman and/or couple who have faced these issues. It is not that I disagree, it is that we work with what we have, not with what we wish we had.


*I lost count of the number of times I suppressed the desire to smack someone who had the gall to "praise" me for having Toddler theBRKP the correct way, i.e not expecting anyone else to pay for his conception and birth and my maternity leave.
**Sarcasm.
posted by theBigRedKittyPurrs at 8:05 AM on August 1, 2012 [3 favorites]


rubbish bin night, out of curiosity, how much did you pay for your prenatal care and hospital stay? We were out of pocket about $1200 that we didn't have, even after paying for medical insurance for years. Then I stayed home with my son until I weaned, which we were desperately unable to afford without paid maternity leave. My partner did have two whole weeks of paid paternity leave, and then I was on my own. If I had needed welfare I would have been forced back to work and to put my baby in daycare, that's how pro-breastfeeding this society is.

That's where the resentment and anger comes from, at least from me. Sure, push breastfeeding all you want, when it comes down to it women literally cannot afford to breastfeed because they do not have the support or the money. Those free formula bags mean a lot to women who can't breastfeed. They shouldn't be given to women who will be breastfeeding, but banning them entirely--is the city going to make up for it by putting more money into WIC? Into maternity leave? No, they're not.

It is about money, at its root, and pretending like it is about women who just need more education and less access to formula makes me shake with anger at the hypocrisy of it all.
posted by the young rope-rider at 8:17 AM on August 1, 2012


Oh and since you're not American, WIC is the program that helps pregnant women and infants get food and formula (and breastpumps sometimes). It stands for Women, Infants, and Children. If you want to see what the real problem is here, google "WIC cuts". Maybe women, infants, and children would be healthier if they had enough to eat, period, regardless of whether it comes from a breast or not.
posted by the young rope-rider at 8:24 AM on August 1, 2012


Hey, young rope-rider, steady on - I tried to make it clear that I am all about choice when it comes to breastfeeding, and that formula is freely available even in baby-friendly hospitals. It just isn't *given or promoted by the manufacturers*.

As an aside, one thing that drove me up the frickin' wall when breastfeeding my son was how people kept saying, "And it's free!" Yeah, right. It's free if you consider that the mother's time has no value. I was the sole breadwinner at that stage, and it cost us a bloody fortune for all the work time I missed to feed my son (long story; Dutch mothers of young babies are entitled to spend 1/4 of the working day breastfeeding, but for those of us who are self-employed it means that if you're not working, you're not getting paid).

I can't help thinking that your asking how much I paid out of pocket for my maternity-based expenses is a rhetorical question given that I mentioned that I live in NL, which has (a form of) socialised health care. I don't want to be coy though, so I'll say that my out-of-pocket costs were zero. Zilch. Nada. Pregnancy- and birth-related health care costs are fully covered by the insurance company here, thanks to government legislation. I know just how lucky I am (that was for a week-long stay, general anaesthetic, blood tranfusion, a few days in the NICU for my son), but that's a whole different story of course.

I know what WIC is and - again - I agree with you that nutrition is nutrition, whether from a breast or a bottle. Plenty of kids here in NL are bottle-fed and we mostly turn out ok.

I guess my question is, do they really give out such enormous amounts of free samples in US hospitals that it makes a major difference to family budgets (and yes I do understand how much difference even a single dollar can make to many people). I freely admit that I have never seen a free formula bag so I don't know what is in them or how much you get.

Believe you me, I am no fan of the many things which are used to divide and conquer women and make us feel guilty about doing or not doing whatever it is we do or don't do. I think that you and I are actually on the same side of this discussion. But again, I admit that I don't know how things really are on the ground in a US hospital so I bow to your greater knowledge (and I don't mean that sarcastically!)
posted by rubbish bin night at 8:54 AM on August 1, 2012 [1 favorite]


I don't have a huge amount of time to respond to you thoughtfully but I did want to say that my crabbiness is not directed at you at all, and I apologize that it seemed that way!
posted by the young rope-rider at 8:55 AM on August 1, 2012 [1 favorite]


This is the liberal equivalent of the mandatory transvaginal ultrasound. Shameful
posted by tehloki at 9:02 AM on August 1, 2012


rubbish bin night: "I can't help thinking that your asking how much I paid out of pocket for my maternity-based expenses is a rhetorical question given that I mentioned that I live in NL, which has (a form of) socialised health care. I don't want to be coy though, so I'll say that my out-of-pocket costs were zero. Zilch. Nada. Pregnancy- and birth-related health care costs are fully covered by the insurance company here, thanks to government legislation. I know just how lucky I am (that was for a week-long stay, general anaesthetic, blood tranfusion, a few days in the NICU for my son), but that's a whole different story of course."

Holy crap. We should all move to the Netherlands.

Our pregnancy-related medical costs were around $20K. Copays for medications, procedures, the OB, specialists and the perinatologist visits cost us thousands even before my wife gave birth.
posted by zarq at 9:07 AM on August 1, 2012


Oh god the expense.

I've mentioned before that my first baby came fast and was delivered by firefighter. Then we were taken by ambulance to the nearest hospital (not where I planned to deliver) to get checked out and recover. We were absolutely fine, I needed two stitches, my baby got the usual newborn workup but otherwise no complications.

first bill from hospital: $16,000.

Bill from ambulance: $1,200 for me, and $1,200 for my son. ( I called the ambulance company and said "hey, it was one ambulance" and they said "oh, but there were two patients inside") Note that the distance from our house to the hospital is approximately 1.1 miles.

Bill from fire department, for actually delivering the baby: $0.

Socialized medicine looks pretty damn good.


The freakout from the delivery meant that I had no milk, no colostrum even, for three days. Dry as a bone. Every shift change brought a new round of crusty nurses who would ask "how the breastfeeding going" I would say "my milk hasn't come in yet" and they would immediately say "everyone thinks that" and reach out and squeeze my breasts without so much as a by-your-leave and then say "oh, it hasn't." Sheee-it. Breastfeeding was a struggle for the first few weeks. I needed a lot of help. I was lucky to get it.
posted by ambrosia at 9:25 AM on August 1, 2012 [3 favorites]


The only formula my baby drank was the free stuff we got in the hospital. It tided us over until my milk came in, and did nothing to harm our breastfeeding relationship. In fact, I wish I'd used more of when she was a wee baby, because by 4 months, she absolutely refused a bottle (even of breastmilk), which meant that until I weaned her last month, I could not spend more than 4 hours away from here EVER. This did not do good things for my mental health or my marriage.

For the women I know, it was because of work, medical issues, or latching issues. A very small minority didn't breastfeed for other personal or cultural issues. All their babies are fine.

I'm reflexively opposed to this policy, because I think that a woman's right to choose what to do with her body rules out in this case. However, I do admit that this article, which claims that babies who are not supplemented with formula in the hospital are 2.5 times more likely to successfully breastfeed, does sway my opinion. But it also claims that pacifiers reduce breastfeeding, while simultaneous linking to an article that claims the reverse, so who the hell knows.

And I think that's the gist of the issue for me. We DO know that support for breastfeeding in the form of family-friendly maternity policies, letting babies room in with their mommas in the hospital, and extended access to lactation support. But instead of working on these (admittedly difficult) solutions, we're latching on this weirdly paternalistic and, as far as I can tell, unproven idea. Rather than support the mothers, we're just going to throw more hoops their way. Bah to that.
posted by snickerdoodle at 9:30 AM on August 1, 2012 [5 favorites]


Our pregnancy-related medical costs were around $20K.

*Jaw hits floor*

I dunno if our were even 1k, beyond what our insurance covered, and my partner was identified as a pre-eclampsia risk so there were visits to the hypertension clinic et al from about three months going forwards. America... yikes.
posted by smoke at 4:12 PM on August 1, 2012


We had complications. Very difficult pregnancy. It wasn't typical.
posted by zarq at 4:40 PM on August 1, 2012


Wow, those cost for Americans are *insane*.

I am lucky to live in Canada, and to have had my midwife care also covered 100% by the government. My birth was difficult, and care had to be transferred to an OB for the actual delivery...but my midwives stayed with me the entire time. Then my midwives had home visits throughout the first two weeks after I was released from the hospital, including coming three times in one day when I was having trouble with breastfeeding! The last visit, after 10pm, she brought a feeding tube so that my baby could drink formula while sucking on my breast - to ensure she would get the calories & nutrition while still stimulating milk production before my milk came in. All of this, of course, was free of charge to me.

I would not have been able to successfully breastfeed without that level of help. I am very lucky to live in a country where that sort of care is offered to all women, regardless of income.

However, I still ended up switching to formula over time (introduced at 3 months, full time at 6 months) since my baby preferred the bottle...i.e. screamed every time I brought her to the breast. Even with enormous social supports, some women choose not to breastfeed for a year. (I say choose, because I could have put my life on hold to keep pumping all day and feeding my baby breast milk bottles.) This doesn't make me a bad mother, although I thought that for a long time. I think that there is way too much of a societal focus on *how* women feed their babies. The important thing is that they are being fed and cared for.
posted by barnoley at 6:18 PM on August 1, 2012 [2 favorites]


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