Last week an interesting item in the news concerned that little state of Rhode Island, where hospitals are the first to go 'bag free' - stopping the practice of "free" formula giveaways to every mother who gives birth. I mulled this over for a while. At first, I thought "hooray!" because I breastfeed and think formula companies are, as are most companies, fairly insidious beasts. Then, I stopped and thought, wait, is this bad for moms who want to formula feed but don't have a lot of money? Then I thought longer and realized, as so aptly put by Jessica over at the Leaky B@@b in her great series on "unsupportive support" of breastfeeding, that this formula isn't really "free" nor is it helpful to women. The costs of providing these millions of dollars worth of "free" samples of formula to hospitals is of course, passed on to the consumers of the product (you didn't really think formula companies were altruistic just because they make cute looking ads with happy looking babies in them, did you?). Formula is ridiculously expensive - as a momma who only breastfeeds, I have often said I have no idea how people afford to buy formula. Same with disposable diapers, but that's a topic for another time.
Anyway, the Rhode Island policy is not to ban formula giveaways in the hospitals entirely as some seem to be recounting, rather, they will only give the samples to those moms who experience difficulty breastfeeding (whatever that means - it's hard! we all experience difficulty). Point being, it's not as if women will be completely shut out from receiving the samples if they so desire; however, the policy of the giveaway no matter whether a mom wants it or not and as a routine matter of course is done with. And good riddance. As the article from NPR I linked to above points out, according to the CDC, only 38% of Rhode Island mothers nurse their babies six months after birth, compared with 44 % nationally. Read that again. Both numbers are atrocious. Especially when you consider the AAP recommends breastfeeding for at least one year and WHO recommends breastfeeding for 2 years and beyond. So what is going on here? I really think, as do many others (and there's been research on this), that lack of support in the US is a big factor in why so few women are still breastfeeding at 6 months. This lack of support includes in the medical community, in the womens' social communities, and in the workplace. There is also a huge lack of education on just how beneficial breastfeeding is for your baby and for you as a momma - especially for those in low income communities.
I should come out and say, I am not only a breastfeeding momma, but I am still nursing my almost 16 month old. I should also say, I never thought I would breastfeed this long and had no intention of going beyond a year, but I am so happy I still am and so is Tiger (he's a boob man). I think Jessica hits many good points in her blog and I won't repeat them here (it is a post worth reading), but the most important is an understanding that formula companies are a business. And like any business they are looking to attract customers and make profits. They will go to great lengths to do this. Did you see the ads for the chocolate flavored formula? Thankfully, public outcry led to a quick cease in production of that product, but again, formula companies are businesses. They may try to get you to forget that - and they may act as if their free formula samples and "breastfeeding support" hotlines are really just helpful and not at all geared toward undermining breastfeeding, but don't for a second believe it. What business model ever was successful in encouraging women to do something that guarantees the women won't need their product?
Here's my experience - with my first pregnancy that ended in miscarriage (see previous posts), I bought some maternity clothes (my first ever) and naively gave my name and mailing address to the cashier at Motherhood Maternity when she asked for it (I blame pregnancy brain for this incredibly stupid lack of judgement). Anyway, I began getting all sorts of mail - most of it from formula companies and cord banks (as if I have the money for that). It was bad all around. And it kept coming right up until the date my baby was due, which was doubly awful since I lost the baby in my 13th week and every time I got the mail, I had to be reminded of that sad event. Within a week of my name being sold (thanks, Motherhood, you evil mofos) to these companies, while I was still pregnant, I came home to find a nice brightly colored package on my porch. Yay!, I thought. Goodies! Well, what was in that box but 6 cans of similac formula "free" for me. I was probably 10 or 11 weeks pregnant and I had no idea yet what I wanted my labor to look like and hadn't given a thought to how I would feed my baby. I thought at the time, "that is so generous! I will put this away in a drawer for when baby is born because I'm sure it'll come in handy." And so it begins. By the time I had Tiger, I knew better. I knew I was going to breastfeed exclusively and I had a good lactation consultant in the hospital and breastfeeding support through my midwives and doulas, but after Tiger was born, he had to stay in the hospital because he was jaundiced. All my friends and the aforementioned supporters kept telling me the best way to get his biliruben levels down was to nurse. So, I was happy when my milk came in on the third day after he was born and I nursed him near constantly while he was still in the hospital. But, the pediatric staff at the hospital didn't agree - I was literally told I was "brain damaging" my son because I refused to let them give him formula. When I did finally relent, he spit it all up - so they gave him soy formula (turns out he was allergic to both). When he was transferred to NICU at another hospital, they sent me off with a box of soy formula telling me I HAD TO SUPPLEMENT OR HE WOULD DIE. I'm not kidding. The NICU was much more breastfeeding friendly and supplied me with a pump and storage bottles, and a place to do my business complete with a radio and magazines. They very much encouraged giving him breastmilk and their literature on jaundice even said in the first paragraph that nursing was the best way to bring the bilirubin levels down. But, I couldn't pump enough this early in the game and so they supplemented and gave him way way too much for his tiny tummy in an effort to reverse the levels. When he was ready to be released two days later, I met with the lactation consultant who assured me his latch was good. I was then given his discharge papers which said he needed 5-6 ounces of milk per feeding and that I needed to supplement with formula. They then handed me this nicely wrapped box of free formula (I later gave it to a friend who couldn't breastfeed). So many things are wrong with this scenario (5-6 oz? for a newborn? and that implicitly undermines breastfeed because as I asked our pediatrician the next day, how will I know he's getting that much if I'm nursing and not bottle feeding?). My pediatrician saw him over the next 2 days and immediately said we didn't need to supplement, he was back up to birthweight, the jaundice was gone and would not return. "Just feed on demand," she said. The sweetest words I wanted to hear.
My tale is illustrative, I think, of so many practices in this country. I can count very few women I know who have delivered in a hospital (that was my first mistake) who have not been sent home being told they had to supplement with formula, whether this was medically necessary or not. Also, most babies seem to be given formula as a supplement while still in the hospital. Why? Because it's there, it's free and many people, even medical staff, don't understand breastfeeding - especially in the early hours of a newborn's life. So, I applaud RI's policy. As Jessica points out in her blog, women who truly want and need formula and can't afford it, can receive aid through other sources to obtain formula. Also, the RI policy does not ban these women from receiving the "free" samples.
This is not about breastfeeding vs. formula feeding, although I know it touches that nerve in many women who "don't want to be told they should breastfeed." My quick response to that is if something is safer and healthier for your baby, don't you want to be told about it? Whether it be a medical procedure, a product on the market, or a medicine? If you then choose to ignore that advice for whatever reason, so be it. No one can make someone else feel guilty - we are all responsible for our own emotions and if you choose to feel guilty, you may want to investigate why.
Happy nursing everyone! May RI's decision be parroted in other states, including my own. I hope that the policy change also includes the decision to ensure that women get the support they need because as I have said to many new mommas, breastfeeding is f$##ing hard! But, with the right support, almost every momma can give that gift to their baby and to themselves - and everyone wins (except the formula companies!)
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