Formula Marketing Hits a New Low -- as in "Lower in a Key Nutrient for Brain Growth"

While attending a perinatal conference recently, I picked up some formula company literature.  I had noted that FCs were marketing a "gentle" formula for babies who were having trouble tolerating formula (not surprising as babies were not designed to tolerate well anything other the human milk).  Mead Johnson had removed 70% of the lactose, Similac had removed 80%, and Gerber had removed 98%!

Why is this significant?  Well the primary carbohydrate in human milk is lactose.  Lactose is critical for brain development in babies. 

I asked one of the reps if there were any studies of the effect of removing this vital brain growing nutrient from this product.  She could not think of any, but will look and if she finds any, will send me copies.  I could genuinely thank her for doing this for me.

I asked if her (or any company) put a warning on the packaging about this.  If a mother was having a problem with a fussy baby, and was tempted to change to this lactose lacking formula, she might reconsider if she could read a caution on the packaging.

Of course, this was a rhetorical question.  Formula companies do not list risks of their product on their packaging.  They only tell consumers how close formula is to breast milk, or that it contains all the nutrients required for a healthy baby.  They even proclaim how  (algae derived -- NOT disclosed) DHA, probiotics, choline, and other additives support brain growth similar to breast milk.  They do NOT list how using their product increases baby's risk of asthma, diabetes, leukemia, lymphoma, GI diseases, etc.  They do not discuss how their product decreases the baby's IQ when compared to breastfed infants, or that the brain is actually less developed as seen on MRI studies. 

In addition to the "gentle" formula, the FCs now advertise a "supplemental formula" for breastfed babies.

When asked by the rep my opinion of their packaging, I told her that I felt it was deceptive.  I have no trouble with formula companies marketing their product. There was a place for it.  However, I did not like incomplete disclosure or misleading phrases they consistently use in their marketing.  I explained that many mothers would see this "supplemental" formula for breastfed babies as "something close to breast milk, unlike the other formulas".  In reality, it is very similar to the other formulas.  Only a few ingredients were slightly tweaked.

At this point, the rep told me that her company was the last to market both the "gentle" (dumb down?) formula AND the supplemental (for breastfed babies) formula because of their commitment to integrity in marketing (What?).  She stated they finally had to do something to prevent some of an increasingly limited market share going to those competitors.  Really?  THAT is the reason for a formula company adding something "new" and "improved" and "designed" for certain babies, even though, by doing so, they actually are removing a vital, brain growing, nutrient? 

Moms, if you chose to, or have to use formula, think twice about giving your baby a "gentle" formula deficient in lactose.  I may be wrong, but I would not be surprised if we see ten years down the road a population of "gently fed" kid struggling with school work because their brains were starved of an essential nutrient.   We might be seeing this now.  

Many babies have been given plant based formula for years because they were "allergic" to milk based formulas.  But, risking future brain capacity because baby is fussy?  Try to stick it out for a few weeks in order to support your baby's brain, as best as formula can, for life long benefits. 

If you are breastfeeding, and think that this new "supplemental" formula can make breastfeeding easier while giving your baby the same nutrition as your milk without harming your baby's immune system, think long and hard.  Don't be fooled by pretty packaging, carefully contrived words, and smart marketing on social media and elsewhere.  It's really the same old stuff.  Even their latest study on DHA, which they say "proves" babies had higher intelligent scores as children, compared formula fed babies to formula fed babies. 

If you are using formula, save your money.  The FDA requires a certain standard in artificial baby milk manufacturing.  "Supplemental", "DHA/AA", "Gentle" and other formula types are typically more expensive than standard formula with little to no proven benefits.  

Finally, ask yourself if decreasing the amount of crying over a few weeks of time is worth the risk of giving your baby a formula which lacks so much lactose. 

Reflections on a Conference

Yesterday, I attended an all day perinatal conference.  As an RN, continuing education is required for relicensure.  I listened to information on retinopathy or prematurity, screening for cardiac conditions newborns, the variety of newborn screenings available in my state, genetic markers for certain cancers in women, and something called "Mindfulness Meditation", which managed to let me take a little cap nap.

However, there was one topic which elicited a wide array of responses as the presenter spoke:  nods (a few), rolled eyes, whispered comments to a next seat neighbor, expressions of "really?" on faces, and so on.  

In my seat, as the only childbirth educator in the room, I was nodding and inwardly saying "Yes!"  Once or twice I gave a hidden fist and elbow jerk -- you know, the once athletes do when they score points, or what someone does when something good happens and they say "That's what I'm talking about".

As a childbirth educator, I am required to teach according to the evidence, a.k.a. "evidence based practice".  As you know from earlier posts, and probably some personal experience or reading, this is not always the case in the medical profession, especially in maternity care. 

What got me so excited?

The speaker was a certified nurse midwife who was the director of a department and practice at a large medical center in Richmond, Va.   Their c-section rate is only 6%.  Most women labor without medication.  Most of the women who receive epidurals receive a very light dose of the medication so they can still assume some positions of comfort, and cooperate with their bodies to push out their babies.

Women can choose where they want to give birth (the bed, the shower, the toilet, the couch, etc.).  They can choose the position in which they give birth.  They can catch their own babies if they desire.  Babies are not bulb suctioned, bathed (just wiped off while on mom's abdomen), or subjected to any newborn procedures until after completion of the first breastfeeding.  Episiotomies are not done, preserving the integrity of the pelvis floor for the mother's lifespan.   

When babies are born via C-section, they are handed to the mother via a "sterile pathway" so that she is the first contact the baby makes with an unsterile object.  This allows baby to be innoculated with the organisms of her skin vs those in a hospital warmer, etc.  They even swipe the fluids from the mom's vagina and perineum with a sterile gauze and then wipe the baby's mouth and body with it so the baby receives the organisms it would have picked up during normal vaginal birth.  These last two practices help protect the establishment of a normal microbiome in the baby's gut and respiratory tract. An abnormal microbiome increases the chance of asthma, diabetes, and a weaker immune system, among other health issues. 

When the speaker asked the group why they would do such a thing, this lone childbirth educator was the only one who raised her hand to answer.  When the speaker asked if anyone knew what microbiome meant, no other hands went up.  

This does not mean I am smarter than the average bear.  It meant that in a room where most of the nurses worked in a hospital with a highly medicalized approach to birth, they had had little exposure to normal birth and the evidence, based on research, which supported the procedures (or lack thereof), the speaker was presenting.

One nurse suggested that this approach needed to start with the OBs.  The speaker noted that at their medical center, the residents taking a rotation at the birth center so they could learn how normal (and optimal) birth was handled -- or in many cases, NOT handled.  She told us that the hardest thing for the residents was learning to stand by and watch.  They would want to do vaginal exams to check progress, but were told they were not necessary for most of labor and only increased the chance of infection or desire to speed labor up by mechanical or medicinal means.

The speaker also responded to the nurse's comment by pointing out that changes in maternity practice often starts with the mothers.  When women wanted husbands to be present during the labor and birth back in the 1960's and 70's, they used the services of the doctors and hospitals which supported this.  Loosing market share, others had to follow suite.  The same thing is happening now.  The speaker reported that women were coming to their practice from as far away as two to three hours drive, passing hospital after hospital, in order to have more control of how they give birth, yet doing so in an environment in which they feel safe. 

At the end of the session, during Q and A, I asked the group if they had heard of "birth circles" where women get together and share birth stories -- and their opinions of care providers and hospitals in the area.  None had.  I explained there were more than one (actually three) in our area and then shared how this can impact a hospitals bottom line, plus employee's paychecks and job security.  Many hospitals depend on government issued reimbursement checks for patients on Medicaid.  Many hospitals have a high volume of patients enrolled in this program.  But cuts in what the program will allow to be paid can affect a hospitals bottom line.  If private pay, or private insurance pay (at least as long a private insurance is allowed to exist) customers go to places two and three hours away in order to have the birth experiences they want, and in order to avoid unnecessary interventions which carry risks and side effects the women don't want, hospitals will loose market share.  At some point, like in the 1960's and '70s, the light bulb will come on and changes will be made.  

Needless to say, I was thrilled that the nurses were exposed to this information.  I know many of them and they are a passionate and caring and bright bunch of professionals.  Still some will (and did) scoff at what they heard -- but a lot listened and accepted the evidence.  The photos of the smiles on women's faces moments after giving birth said it all.  Many were not in a bed, and were holding their newborns, cord/placenta connection still intact, against their chests.  The incredible joy empowerment they felt was visible in their expressions.

I am looking forward to knowing that those I teach in class will be walking into a labor and delivery environment where the nurses are more familiar with what the mothers are wanting.  I am sure many of them will be even more supportive of "the magical hour", mother's request that the baby NOT be suctioned at birth as a routine, and so on. They will more strongly advocate for the mothers' desires. They will have opportunity to share what they learned with the physicians as they explain why the mothers want what they want.  Information will slowly, but surely, continue to "trickle up" because of the efforts of the patients and their nurses.  One day, more hospitals in our area will be offering, as standard care, the type of approach to labor and birth offered by the Centering Pregnancy group in Richmond, VA.

http://www.obgyn.vcu.edu/pregnancy/index.html

 

Hope Springs Eternal -- in Canada, and MAYBE, Here in the US

It seems to me that breech babies are not God's "oops" babies.  Too many babies have been born breech over man's time on Earth.  But, for a while, C-sections became the "safe" way to deliver breech babies.  Finally, someone (really several professionals) decides to evaluate the literature without the lens of a court and a judge being used.  Guess what?  The literature does not establish that safety of C-section for all breech babies over vaginal birth!  Surprised?  I'm not.  Most babies in the breech and the vertex (head down) position can be safely born vaginally.  

Medical professionals (maybe some midwives included?) in Canada are going to start teaching physicians how to perform breech deliveries.  One purpose is TO GIVE WOMEN A CHOICE.  Another is to decrease the complications which accompany many C-sections for both mom and baby.

Will American OBs begin doing the same?  I hope so.  I heard recently from a doula friend that EVMS in Norfolk VA was beginning to train OB residents in non surgical breech delivery.  That would be wonderful -- for the moms and their babies who want to enter this world feet or bottom first! 

http://m.theglobeandmail.com/life/parenting/pregnancy/delivery/c-section-not-best-option-for-breech-birth/article1186104/?service=mobile

Precious Moms at T4G

For the past three days, my husband and I have been attending Together for the Gospel (T4G.org), a bi-annual conference held in Louisville, KY.   While there I have spoken to several expectant and new mothers, some briefly, others longer.  I met one today who, after two children wants to have a natural childbirth.  I had allowed her to slip ahead of me in the bathroom line (pretty long when about 6,000 people are in the stadium and some of the women's restrooms were converted to men's restrooms because of the 90/10 mix of men to women at the conference!).   As we talked, she asked for some tips on natural childbirth.   I wrote on a paper towel the name of a book, the Evidence Based Birth web site, and other info.  She and I both felt that the Lord had orchestrated that meeting, and I am so happy we met.  Another precious young mother, after having two children, is interested in becoming a doula.  If they, and other read this post, know that you have already been in my prayers.   I enjoyed talking with you and look forward to hearing from you with your birth story, your doula story, and so on.  I am so blessed to have been directed by the Lord into the service in which He has placed me.  Meeting sweet mothers like you is quite a nice perk.

Using Your BRAIN in Labor (and Before and After)

Over the years, I have seen the acronym BRAIN in a variety of childbirth education books, posters, and web sites.  While it is very useful in pregnancy, labor, birth, and early postpartum, it can be helpful in all health care decisions.  

I recently wrote a handout for my childbirth classes (edited slightly for this post), and I am sharing it with you here. The words below, which are italicized, are not in the handout I give to class members, as I teach at a regional hospital. 

The BRAIN Method for Informed Decision Making

When a health care provider advises a treatment, course of action, or medical intervention, remember to use your BRAIN and ask the following questions:

B -  What are the Benefits of this intervention for mother and baby?

R - What are the Risks of this intervention for mother and baby

A- What are the possible Alternatives, both medical and non-medical?

I - What is my Intuition or gut feeling? (question for yourself)

N- What if we did Nothing, or did Nothing at this time and waited a while before intervening?

(Note:  Believers have a special resource.  "If anyone lacks wisdom, you should ask God, who gives generously . . . " James 1:5 NIV.  Even if you feel unsure about your final decision, you can trust in a loving, sovereign God that your decision is in the plan He has had for you from eternity past.  It will the the "right" one for you and your baby in His plan for your and your baby's life.)

EVERYTHING has risks and benefits. No one can control every aspect of labor and birth -- even the best doctors and midwives.  One intervention can lead to another.  This is known as the "cascade" of interventions."  Some results of interventions are not immediately obvious, but show up in the first days of breastfeeding.

Your body is designed to give birth.  Humans are the only "mammals" who doubt their ability to birth their young.  Trust and learn to support the natural process.  Try to intervene only if necessary.  If you have been reading my  recent blogs, you will know that doulas are labor support professionals who know how to support the mother who desires minimal intervention.  Consider hiring one as a member of your birth team.

Sometimes there is need for medical intervention, including the mother's desire for pharmaceutical pain relief measures.  Still, how labor and birth is handled should be based on the research evidence (from the body of research, ot just one or two of many studies).  Care providers differ in education, experience, philosophy, skill, time management, and so on.  These can influence the advice they give in non-emergency situations. That advice can affect your birth experience.   Respectful, open discussion, based on the research evidence, is necessary to make an informed decision.

How labor is handled can affect breastfeeding.  Breastfeeding affects the health of the mother and baby throughout life.  Some intervetions are known to cause problems with the baby's ability to nurse.  They can cause a delay in mature milk production, which can lead to formula supplmentation.  Early formula feedings prevents the baby's immune system from setting up properly.  Certain procedures, like putting baby on mom's tummy immediately after delivery and keeping it there until the baby has self-latched promotes successful breastfeeding.  Labor interventions need to be considered in light of how they might affect breastfeeding.

Whatever the situation, discuss any concerns with your care providers until you are comfortable making your decision.  Once you make a decision, OWN it.  It is not right to make a decision -- whether or not it is in agreement with your care provider's preference -- and then turn around and sue him or her if the outcome is not what you wanted.  If you want the right to make an informed choice, accept responsibility for that decision.  Be prepared to sign a waiver, if necessary, for your care provider's peace of mind if your decision differs from his or her recommendation.

Some News on Water Births Which Might Surprise You

More and more hospitals are allowing and even encouraging women to relax in warm water during the first stage of labor.  Some will not prevent a mother from giving birth in the water if she desires to do so.  Many of the women "catch" their own babies.

I recently read a comment by an OB which was practically venomous in tone.  It was clear that he did not have all of his facts.  It is one thing to question something and another to accuse mothers of attempted murder.

Water birth has many advantages, including decreasing the need for medications which affect breastfeeding initiation, increasing the likelihood of a vaginal vs. C-section delivery, and so on. 

Water birth baby who happens to be breaking it's own membranes ("caul").  Photography by Jane McCrae of www.JaneMcCraePhotography.com

 
Here is a newly released position paper by the American Association of Birth Centers.  If care providers who attend women in labor want to adhere to evidence based practice, they need to consider this position paper before they automatically nix a patient's desire for a water birth.  Certain criteria must be met, as in any type of approach to childbirth.  However, water birth can be a safe option for many women who desire to explore the possibility

http://www.birthcenters.org/webfm_send/145