New York breastfeeding initiative: more control or more choice?

breast vs bottle

On September 3, some New York City hospitals will implement a new policy. Formula will no longer be given to newborns for free. In fact, it won’t be given without a doctor’s order. Instead of being readily available in nurseries, it will be kept locked in a cabinet, and nurses will need written permission to bottle feed an infant.

Most of the response to this idea has been negative. It’s been called a “ban,” a “nanny state”, a push that “forces” women to breastfeed, a move to take away choice.

But as much as I support mother’s feeding choices, I think the naysayers on this one are dead wrong.

Why?

First, let me clear up a few myths that have been circulating about the Latch On initiative. It does not involve banning formula from hospitals so it’s unavailable for babies who need it. Nor does it involve lecturing mothers who ask for formula. What it does involve is a conversation between mothers and nurses before a baby is given formula. Yes, there needs to be a “medical reason” to dispense formula. How exactly that will be applied is anyone’s guess right now — is the mother’s mental health a medical reason? How about her simple desire to formula feed? If you’re planning on formula feeding, will your doctor write a note before your baby is born stating that you plan to formula feed and your  baby can have formula? I’m going to go out on a limb and say probably yes.

But let’s suppose they won’t. Let’s suppose that a woman who is planning to formula feed without a “medical” reason will not be “allowed” to get formula at the hospital. I doubt that’s the case, but even if it were, is this really such a horrible thing? Because here’s the truth: Nothing is free at hospitals. Nothing. They charge you for drinking water, diapers, gowns, and maxi pads. The only thing that’s free to a birthing woman at a hospital is formula, which many women don’t even want. And it’s not free because the hospital is concerned about the well-being of hungry babies. It’s free because formula companies pay for it — out of their marketing budget — and give it to hospitals. Because they know that babies who have formula during the first few days are much, much more likely to become long-term customers. How is that ethical? How is that choice?

And that is why you bring stuff to the hospital. You bring your own chapstick and baby clothes. You probably bring a few diapers and even some toiletries for yourself. Is it really that big a deal to bring some formula if you know you want to use it? And if you’re going to argue that some women can’t afford it, let me point out the obvious that you’re going to have to buy it when you get home anyway, and WIC includes formula.

And in any case, the women who walk into the hospital planning to formula feed are a significant minority. That doesn’t make their needs or desires any less important. But it does mean there are a lot more women who are having the opposite problem. In New York City, 90% of women walk into the hospital stating they intend to breastfeed. But only 39% of newborns are exclusively breastfed. That means around 50% of mothers are not succeeding in their chosen plan. They’re not formula feeding because they want to — they’re formula feeding because something went wrong.

And what went wrong? For some of them, it’s just biology. Their bodies simply don’t produce enough milk and never would have. But, although nobody knows exact statistics on how many women that’s true for, the likelihood is that most women are capable of breastfeeding. Which means that many of these women could have breastfed, and the problem was preventable.

And much of the time, the thing that went wrong was not just preventable — it was something that a medical professional did wrong.

Look, I’m no expert on breastfeeding. I’m just a mom who happens to have been breastfeeding for way too long and who likes to read about it. But I know more about breastfeeding than some medical professionals. I know this because many of my friends have told me things their pediatrician or obstetrician or nurse said to them, and sometimes I know that what the medical professional told them is just plain wrong. Things like “Your baby just needs a few bottles till your milk comes in” or “Newborns only need to eat every three hours, and if he seems hungry more often then you’re not producing enough” or “You should never let him nurse longer than 10 minutes at a time.” These statements aren’t just terribly inaccurate — they’re terribly undermining to a mother’s choices. Because “just a few bottles” means a lot more than a few formula feedings. For many mother-baby pairs, it undermines the whole breastfeeding process to the point that breastfeeding becomes impossible. And that’s a big deal. That is taking away the mother’s choice.

And that’s the real issue behind this initiative. It’s not about breast being best or breastmilk being magic or formula being awful. It’s not about making women feel guilty about the choice to not breastfeed. It’s about stopping practices that force women to bottle feed — practices that are commonly done by people who really should know better.

Take, for example, formula supplementation of breastfed babies. It’s rampant in hospitals. As one friend of mine pointed out in a discussion about this initiative, a woman’s who’s planning to formula feed doesn’t need to worry that a nurse will breastfeed her baby in the nursery. (Cue mental image of a Salma-Hayek-style guerrilla breastfeeding movement, with nurses in masks whipping out their boobs for NICU babies.) But a woman’s who’s planning to breastfeed needs to watch like a hawk to prevent a nurse giving her baby a bottle. Is it really such a big deal to create a policy that adds an extra layer of protection to prevent that? Especially when you consider that a “just a bottle or two” could actually make it impossible for her to breastfeed at all?

The way I see it, this initiative isn’t going to make formula “unavailable” for women who choose it. All it’s going to do is add an extra step so that someone with a accurate information about breastfeeding talks to a mother before she agrees to unnecessary supplementation. If some uninformed nurse tells her that her one-day-old baby needs formula because her milk hasn’t come in yet, hopefully this extra conversation will be enough to reassure her.

Because I’m sorry, but giving out free formula to every mother and supplementing at the drop of the hat is not supportive of mother’s feeding choices. Not at all. Breastfeeding is a choice too, and until we have policies in place that truly support it, none of us are choosing freely.

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