Other than perhaps a brief conversation with her doctor, the formula company literature was all the mother-to-be receives regarding infant feeding. Score-- formula: 1, breastfeeding: 0. Even if there is a conversation about infant feeding, breastfeeding still looses. The best score possible is formula: 2, breastfeeding: 1. Even that is debatable. It would depend on how well the physician knows the topic. It would also depend on any personal bias the physician might have in favor of formula feeding.
Distributing formula samples and formula company written breastfeeding information, coupons, and freebies gives a strong impression that formula really is the health care system's recommended infant feeding choice. Breastfeeding often gets a "Well, we know that breast is best, but ... " This approach to infant feeding education, i.e. giving out formula company literature to cover both breastfeeding and formula feeding information for the mother, has been the case for decades.
Professional and governmental organizations, like the World Health Organization, the Centers for Disease Control, the Office of the Surgeon General, and so on, state that breastfeeding should be "promoted, supported, and protected". They also state that health care professionals should not use formula company literature for patient breastfeeding education.
It is common knowledge among lactation professionals and these organizations that the wording of formula company literature is carefully crafted. Their intent is to increase the chance women will at least supplement with formula. These companies know that if they can get women to start supplementing, mothers will be totally bottle feeding formula sooner than they intended.
Yet, in office after office, all across the country, women receive free cans -- even cases -- of formula, along with advice on breastfeeding. Obviously, there are no breastfeeding "freebies". There is little money to be made by companies when women breastfeed -- except for some companies which make pumps. However, their income does not come near what formula companies can make. The largest formula company in the USA made almost 14 billion dollars in 2012. It sounds like money they spend on direct marketing to physicians and women has a great return on investment. Believe it or not, they stated in their SEC report that they were committed to helping women and babies achieve the best health possible!
Really? That is like trying to help someone achieve the best transportation possible, and giving them a rusty bicycle with mismatched wheels and one flat tire. Their literature tells the buyer that cars are considered better, but that many people find them too hard to drive, that cars are expensive to repair, and so on. They give instructions on now to drive the car, but suggest "supplementing" with their bicycles.
OK, that is not the best analogy, but you get the idea. The problem is, we are talking about the lifelong health of women and their children. Formula companies do not tell women that their product increases the risk of asthma, diabetes, certain childhood cancers, atopic disease, allergies, ear infections (and ear surgeries and hearing loss), respiratory and GI illnesses, and so on for their children. They do not tell women that formula feeding decreases the IQ, alters the development of the babies brain, weakens the immune system, and results in a smaller thymus gland (which supports the immune system) in the child as an adult. They do not tell women that not breastfeeding increases their risk of breast, ovarian, and uterine cancer, metabolic syndrome and diabetes, heart disease, stroke, rheumatoid arthritis, and Alzheimer's dementia.
No, they major on the minor. The tell women that breastmilk is deficient in Vitamin D (not true for most women and babies). They point out how inconvenient breastfeeding can be. They practically insinuate that it is selfish to breastfeed. (See the post "A Lesson in Slick Advertising")
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| Picture by birthing and breastfeeding.com Used with permission of the owner. |
One sympathetic person I spoke with said "The women want the free stuff". That might be true, but I suspect women want something more -- something they might not be used to getting, or realize is missing. They want the respect required to provide them with the unadulterated, research-based truth about their infant feeding choices. They want to know the risks of formula. Only then can they make a truly informed decision. Once that decision is made, they should be respected enough to be given full support, in word and action, for their decision.
I have informally polled expectant women over the years. Almost without exception they tell me "Even if I plan to formula feed, I want to be told about the risks. It is my right. Once I make my decision, I want that decision to be respected". I happen to agree with them.
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| Courtesy of The Alpha Parent. TheAlphaParent.com |
What does all this say to the mother? The experts she depends on for the best care and information are in essence telling her "Breast is best, but formula is the standard, just fine, very acceptable, and quite healthful way to feed your baby. Here, take this sample. Oh, and read the literature in the 'gift bag' to learn about breastfeeding."
Yet, the American Academy of Pediatrics states that breastfeeding is the standard to which all other methods need to be compared. They consider how a women feeds her baby to no longer be simply a lifestyle choice, but a health care decision. I wonder: in what other area of health care is the information limited with regard to the risks of a certain, commonly used procedure? Physician and hospitals have patients sign a paper which lists the risks associated with surgery.
Although not immediately obvious, the effects of formula feeding can be just as devastating as a surgical complication -- sometimes worse. Some hospitals do have women who choose to formula feed sign an informed consent document before they are given formula. This makes sense to me and to others who are aware of the significant risks of artificial baby milk. Like surgery, sometimes the choice to formula feed is elective. Sometimes it is necessary. Either way, it is still an "intervention" into the norm.
I was able to talk with expectant women on their first visit to this office. One of the questions I asked was "What have you heard about breastfeeding". Almost all told me, "not much". I explained five or so of the top benefits (higher IQ, costs savings on formula alone of up to $3000, decreased risk of asthma and diabetes, and decreased risk of childhood cancer. For mother: decreased risk of developing breast, uterine and ovarian cancer, decreased risk of developing heart disease, stroke, Type 2 diabetes, and Alzheimers dementia), Not surprisingly, their interest in breastfeeding shot up significantly. I encouraged them to do an online search on their feeding options, including risks of formula feeding, to talk with their doctors, and then decide what they wanted to do.
Just so you know, I made it clear at the onset of the conversation that the choice of what they wanted to do regarding infant feeding was theirs to make. Their care providers would support that choice. I was giving information out of respect for their capability to make the best decision for themselves and their babies. I just wanted to make sure each mother had the information to make an informed decision. I also make it clear, when discussing the feeding effects on IQ that formula feeding does not mean the baby will become the village idiot. A lot of smart people were formula fed. However, the evidence in obvious in how breastfed babies do in school. Research shows they do better.
Every one nodded, and some even smiled. I believe they appreciated the respect they were given. One even said "Thank you."
One mother told me "I formula fed my first child. He has (one of the ailments). I am interested in breastfeeding now I know it might prevent it in this baby". The mother of multiples was amazed at the cost savings (up to $6000 in the first year for twins/$9000 per year for triplets!) Her mother in law was with her for the visit. This grandmother to be told me after pulling me aside that she had nursed her first baby only a few days, but nursed each baby over a longer and longer period of time. She proudly told me that her youngest, a daughter, was in pharmacy school. She said "I always knew she was more capable mentally than the others. Now I know why." Another mother told me, "I was planning on formula feeding, but now that I know about breastfeeding, I am going to think about doing that."
WHY didn't these women -- especially those who had delivered other babies -- know more about the difference in breastfeeding and formula feeding on the health of their babies and their own health?
Women are not brainless creatures. They do not need a paternalistic medical system to make decisions for them by limiting the information they receive. "We don't want to make women feel guilty if they want to formula feed" is NOT justification for giving out formula company propaganda. It certainly is not justification for not telling women the risks of formula feeding and why breastfeeding is the biological norm for feeding their babies.
Even the US government, in one of its educational books on breastfeeding, points out the "risks of formula". These books are printed by the millions and made available free to American women via health care organizations, lactation consultants, and so on.
"Breast is best, but formula is also good" just does not cut it.
The free formula can keep a worried mother from asking for help with breastfeeding This "rescue baby food" is within her reach when she is vulnerable. She gives her baby a bottle . . .and then another ... and then another. Very soon, she "can't make enough milk", or her baby refuses to latch onto the breast. Formula companies know this. They count on it. The formula company has another mother and baby, literally, in it's ill-gained money filled pocket.
This issue prompted me to develop the following poster a few day ago. I wish I could have put it in the nurses' station and the OB offices yesterday! I would love to see it or something like it in every nurses' station and physician's office in OB practices across the nation. It would be great reminder, and also help them become familiar with the risks of formula feeding -- information they could pass on to their patients. A real dream would be a poster like the "FYI" inset poster to be displayed where patients could see it. However, I know better than to hold my breath while waiting for this to happen.
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| Poster for OB offices and nurses stations. Use the FYI poster for patient education. Both posters available by clicking on page tab at the top of this blog. |
Guilt might be a problem for women who still choose to formula feed. It is something we all deal with when we make a health care decision knowing it is not the best one. Sometimes, due to circumstances in our lives, it is the best we can do. Of course, those feelings can be intensified because women realize they are making a health care decision for their own children. If breastfeeding is not the choice or not an option, it is important to remember that genetics and nurturing also impact the child's development. It doesn't all hang on breastmilk alone. Still, breastmilk is a major factor in optimal growth and development, and that fact can not be denied.
Some women say "My children are just fine" as a defensive mechanism when they feel some guilt. When compared to the general population, they are "fine". But, when compared to breastfed children, facts are facts. Their children, at some point in their lives, do cope with some health or developmental disadvantages which breastfed children and adults experience to a lesser degree or not at all. Sometimes those disadvantages are not so mild -- they can be devastating.
"Bad" feelings might follow situations where women can not breastfeed, It is sad when breastfeeding, in rare cases, is simply not an option. Adoptive mothers who can not produce milk after trying to do so can feel this. Women who have endocrine disorders which limit their milk supplies still feel bad they can not breastfeed their babies totally.
These are honest, normal emotions. We all experience them when our best efforts do not produce the results we desire. This can be in the area of our health, our finances, our children, our careers, our relationships, and so on. This is simply part of life. I have put down my thoughts on how to deal with any "infant feeding disappointments" in the post "But What If" and also in "When Breast is NOT Best". Perhaps they might be of some help if you are dealing with any negative emotions related to formula or breastfeeding decisions or circumstances.
A much worse emotion to be vented toward the care provider is anger. Anger that the health care providers women trusted in did not see fit to give them all the facts so they could give their informed consent to formula feeding.
Even worse is the distrust that develops toward their care providers when the mothers of children with severe asthma, or diabetes, or battling a childhoood cancer learns that the disease and the stress on all of the family which resulted, might have been prevented. It might have been prevented if had they been given the truth about the risks of formula feeding or had they been given 100% support in their efforts to breastfeed while in the hospital.
Health care providers will truly earn that name when they stop saying what formula companies love to hear: "Women might feel guilty!" "Benefits of breastfeeding" (vs. "Risks of formula feeding") and so on. Informed decision making, and informed consent requires full disclosure. It is given in every other area of health care. Expectant and new mothers deserve the same respect.
This blog is supposed to be about breastfeeding from a Christian perspective. What better perspective on providing full disclosure to expectant women than "Do unto others what you would have them do unto you?" or "Love your neighbor as yourself."
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