Friday, August 3, 2012

Locking Up Formula

Today I woke up to this article about a new health initiative in NYC to "treat formula like any other regulated substance, keeping it locked up and given out only under certain conditions."

This makes me furious. Similar to regulating the choice of drink size, this is yet another initiative to take away our choices rather than provide us with more options to help us.

Here are the largest barriers I found to breastfeeding, none of which are being remotely addressed by this initiative:

1) It hurt a lot at first and I didn't see a lactation consultant until I was already in agony

2) My pump cost over $200 and insurance refused to contribute

3) My job was not particularly friendly to pumping

But instead of helping women to subsidize pumps, adding more lactation consultants, or doing anything to give women more protected time to pump, let's instead just take away formula for the two days the baby is in the hospital. That should do it.

Better yet, why not add a sin tax to purchase of formula? Because that's what they're saying: Giving your baby formula is a sin.

33 comments:

  1. EXACTLY!! Most women start breastfeeding and stop in the first 1-2 months and it's not because they got $8 worth of formula in the hospital. If it were the case, they'd never start.

    A few things:
    I pump in a coed shared office that doesn't lock. I mean, we DO have a desk (no chair) with an outlet in the bathroom or I COULD walk the 20 min each way to the lactation room across campus but neither of these seem reasonable. The only place we have to clean parts is the chemical sink in lab or the bathroom sink.

    My pump is >$300

    Between the pump, accessories, freezer, and materials for storage we've spent as much or more on pumping than I would if we switched to (generic) formula. Every time someone says "breast milk is FREE!!" I want to punch them.

    If breastfeeding/pumping were made easier and more cost effective more women would be willing/able. It's pretty simple.

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    1. Pumping supplies, bags, etc, are quite expensive. Insurance pays for none of this. I may have saved a little money total, but nothing worth the amount of effort it took.

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    3. There are cheaper ways to pump. one can buy a commercial grade pump on ebay, one that is sellable after you are done with it.
      Most people have a freezer in their home, so that usually isn't a necessary expense.
      A friend who was a great producer, rather than buy disposable bags, just bought about 25 extra bottles and used those to pump and freeze in.

      The efforts to Nurse and pump are herculean, but the costs don't have to be.

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  2. As someone who is very pro-breastfeeding, this policy strikes me as poorly thought out paternalism. A few points:

    1. Is there any scientific evidence that these policies increase breastfeeding rates? By contrast, there *is* evidence that making things more difficult for new moms leads to worse outcomes for the mom and the baby.

    2. Will this policy lead to increased rates of jaundice and more babied failing to regain their birth weight by week #1 or 2? Most likely. Which will (paradoxically) likely lead to increased rates of formula feeding later on, and increased medical costs via more doctor visits and increased testing in the first few weeks after birth.

    3. Third, I'm trying to imagine how difficult it's going to be to get formula in the hospital. From personal experience, I can tell you that medications *rarely* arrive as scheduled. Creating additional barriers to feeding the newborns is likely to create additional burdens to the already overstretched nurses, lead to unhappy fussy babies, and unhappy parents.

    4. I can only imagine the third degree the nurses are going to give the formula feeding moms. For goodness sakes *I* got the third degree when I requested 200mg (rather than 100mg) of colace after my c-section, which is still well below the over the counter max dose. Colace! Dealing with attitude from the nursing staff about reasonable requests is trying under the best circumstances, and completely horrible when you're already tired and in pain.

    5. Breast feeding should be thought of as a joy and a privilege, not as drudgery. These policies make it something you *have* to do rather than something you *get* to do, and paradoxically may make it seem more unpleasant to women who would have gladly done it anyway.

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    1. Yes. This is what I would have written had I been able to gather my thoughts properly. It's unclear that any of this will help increase BFing rates.

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    2. The concept of locking it up and holding the distributors of the product accountable, which i think is missed, is that the hospital is giving a substance to an inpatient that could be tainted and recalled, and, thusly, the ability to document the lot numbers and find out who had which, would be helpful if there is some sort of recall.

      I'd also like to address the reasoning for keeping it out of view. When someone is trying to make a behavioral change that is difficult, it helps to diminish the exposure to things that can sabotage them. You wouldn't keep alcohol in site of someone struggling in their sobriety, would you? So why would you have easily accessible, visible formula around for nursing (stuggling) new moms??
      It's the EXACT same concept of why woman who want an all-natural labor (like the bradly method) SPECIFICALLY state they do NOT want an epidural OFFERED. They know that they can ask for it, but they know that when you are in pain, and struggling, and exhausted, if someone offers you a way out . . . you might just take it, even if that wasn't really what you wanted (when you thought about it rationally, and prepared for months), and isn't going to make you happy after all is said and done.

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    3. 1. Formula is not Alcohol
      2. Getting one bottle is not going to "sabotage" anything unless you want it to
      3. Personally, I've always found the demand not to offer an epidural to a laboring woman a bit asinine. I mean, HOW DARE the anesthesiologist or Ob want to help the laboring and in pain woman with an intervention that works and has minimal downside. Whatever floats your boat though.

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    4. 4. I think it's the lecturing/arm twisting and the lock and key aspect that people are objecting to anyway. However, you're implying that the alternative to not dispensing lectures is that formula be pushed down the throats of these poor women who really wanted to breastfeed, but now are having their resolve tested. When i had my daughter, I was asked in an open ended way how I planned to feed my baby, and that was that. The end. Nobody ever offered anything.

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    5. I think comparing offering formula to a new mother vs. alcohol to an alcoholic is a pretty ridiculous analogy and pretty much defines the problem. Some women may need the relief of the baby getting formula. I personally had a very hungry baby who would literally nurse for 2-3 hours in a row, and my nipples were almost bleeding... I let her get a small amount of formula to give me a short break from the agony. No harm done... she breastfed for a full year. If you want to record the formula lot number in case of a problem, that's fine. But that's definitely not the purpose of this initiative.

      I also don't think it's unreasonable to offer an epidural to a laboring woman. Why is offering pain relief to someone in pain a bad thing? My husband was passing a kidney stone baby and was offered pain relief for that, and he wasn't at all offended. Do you think patients in other sorts of legitimate pain shouldn't be offered pain relief? What's so special about childbirth that we shouldn't be given the same options as other patients who are in pain?

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  3. This makes me so angry! When I had my son, I was determined to breastfeed - never even considered formula. That is until I realized that I was having a LOT of trouble with breastfeeding and my son started rapidly losing weight! If it weren't for the formula at the hospital (which I received immediately after I noticed that the BFing wasn't going well), I honestly don't know what I would have done. Especially since my son was born in the middle of a huge snow storm and it would have been very difficult to obtain.

    In the end, I had to supplement with formula at least once a day because my supply was so low and I was in so much pain for the first 4 months of his life. I saw the formula as a way to ensure my son got what he needed so that I wouldn't have to worry about him losing weight while I was trying to figure it out.

    Shame on the state of NY for punishing those women who can't or don't want to BF and by making them feel like crap. Like motherhood isn't hard enough without the politicians weighing in.

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    1. I think most women who give up on BFing do it in the first few weeks, not the first few days. I have no idea how this will help, and it might hurt babies who are jaundiced and need the milk. And it really attaches a stigma to using formula.

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    2. The woman are allowed to feed their babies whichever way they want. They just proclude someone formula feeding your child without your permission. If you want to use formula, formula will be given.

      It's akin to immunizations: we feel there are public health benefits. You will be told the benefits of immunizations, and the risks, too. You deserve to know the risks of artificially feeding your child. If you would like to go ahead, that is your perogative. Also, if medically your child needs this feeding, the substance is available and will be given, but the lot numbers will be logged in case there is a recall.

      You still have the choice, but now it comes with some factual information and some security in recording it like any other artificial substance your baby is given.

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    3. "Artificially feeding your child" Are you serious!!! You need to wrap your mind around the fact that formula is food and is a perfectly acceptable way to feed a baby. You also need to do some research on the historical alternatives to breastfeeding. Guess what? Despite what you may have been told, women throughout history have had difficulties breastfeeding and the option of a live-in wet nurse was only available to rich women. The middle class and poor alternatives were: give your baby to another nursing woman (to live with and raise) until the baby weaned, feed the baby all-natural cow or goat milk and watch the baby fail to thrive (but live!) or the baby starves. Formula is an excellent alternative to the above scenarios and mothers should not be made to feel bad about giving an "artificial substance" to a baby that, in fact, keeps the baby alive and thriving.

      The list of ingredients on formula that seem like a bunch of unpronounceable chemicals is really the chemical names for milk, fatty acids, amino acids, vitamins, and minerals. Most of the list is also in breastmilk.

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  4. I have read a few of the articles online, and I can't seem to get a consensus on how this is really going to work. Some sites are stating that it is just not going to be handed out - that their has to be a need or request. If that is the case, then I see no problem with it. And since you can get the "same" cans from the companies via the mail for a trial, it doesn't mean women won't have access to some free formula in cases like Kasiunut (which is why I also have 2 sample cans on hand just in case).

    Also, if you have read the new provisions that went into affect this week as part of the affordable care act, insurance companies have to help pay for breast pumps now. That is a federal mandate, so the states probably don't need to do anything on top of that...

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    1. It's not clear how this will work, but obviously the purpose of this initiative is to make it harder for women/babies to access formula. If not, then I don't know why they're doing it in the first place.

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  5. Also, for those of you who watch the Daily Show, I can just imagine Jon Stewart doing a bit where he compares the amount of weed that's legal compared with the amount of soda or formula that's illegal.

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  6. Why reinvent the wheel? We could go with this instead, since it's a longstanding WHO program the US has been ignoring for decades.
    http://www.who.int/nutrition/publications/infantfeeding/9789241594950/en/index.html

    Add on bf and parenting friendly workplace policies to support it after d/c and then talk about success.

    The reality is we are lucky we have access clean water, WIC subsidies and other resources that make the decision to formula feed even remotely safe. However it is still the inferior choice.
    -KASW, m.d. and mother of two,both adopted and breastfed

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  8. Why not just ship all the mommies off to third world countries? Good motivation for breastfeeding--the very survival of one's child. Plus there's no access to formula so no need to waste time and paperwork figuring out ways to control it. Problem solved? Jon Stewart really does need to get a load of this.

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  9. there is a tonne of access to formula in third world countries. ever heard of the Nestle boycott, for example?

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  10. Just pointing out that the Affordable Care Act's preventive services for women includes breastfeeding support (lactation counselors), protected work spaces and time to pump, and reimbursement for pumps and supplies. Those pumps are covered right now. It also covers private spaces to pump at work that aren't bathrooms.

    http://www.healthcare.gov/news/factsheets/2011/08/womensprevention08012011a.html

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  11. While I agree that this specific intervention and the way that it is being administered (an order from the Mayor, really?!?) are flawed, I think the general idea of implementing some sort of institutional/bureaucratic change to encourage *the medical staff* to give primacy to BF is a good idea. We don't have the rates of success we could have, for LOTS of reasons, one of which is that, in my experience, it is easier for nurses to offer formula than to support breastfeeding. Perhaps this is a wrongheaded effort to make the opposite true. YES, absolutely, we need other sorts of reforms as well, like logistics and cost reform regarding pumping in the postpartum (then again, breasts need to be emptied regularly and that is contrary to efficiency at work, I agree, but I also don't think we've done what we can as a society to maximize that efficiency yet). Which, in short (ha) is why I admire this effort but I imagine it will be ultimately insufficient. The difficulty in changing a broadly flawed system is that wholesale reform is impractical and arduous but piecemeal reform is ineffective and disoragnized. There's really no way to win in this case.

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  12. That's just ridiculous!

    My mother co-fed me breast milk and formula because she couldn't produce enough and I wasn't gaining weight like I should have been.
    The clinic she went to didn't believe her (claimed I wasn't used to nursing and just needed to get used to that 'full mouth feeling') and so put a supply line on, I grabbed the supply line and slurped that up because I was so darned hungry apparently.

    Some women just can't breast feed physiologically as well as having massive social and logistic obstacles.

    This is the opposite of good health promotion (which we are studying this semester), it won't do anything but harm to those who need it.

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  14. There is no doubt that the availability and use of formula is a contributor to early cessation of breastfeeding. Formula use is such a slippery slope- a lot of mothers think they do not have enough breast milk, or are not able to produce when in fact only a very minute percentage of women cannot actually physiologically produce enough milk to feed their babies. Perceived inadequate milk supply has many facets, with one of the main underlying causes stemming from supplementation unnecessarily. Having said that, i think the underlying problem is not that there is the presence of formula per se, but the lack of support for new mothers. What is considered 'normal' and 'natural' does not always come 'naturally', which could lead to fear and frustration, and then naturally supplementation and/or cessation follows. We need support to learn this new skill; we have lost breastfeeding as a cultural 'norm'. We do not grow up observing breastfeeding behaviour, or teach our girls about the importance of breastfeeding as they grow up toward becoming mothers themselves (studies show that pre-pregnancy intention is a huge factor in breastfeeding success). We do not support mothers enough pre- and post-birth, at home, at work, in public etc to breastfeed. I could go on and on; I wrote a 20 page literature review on factors to duration/early cessation, and I could have written a 3000 page book, as there are so many intricacies to this issue.

    I would like to see something like the WHO breastfeeding-friendly initiative implemented in hospitals instead of outlawing formula. That feels like a band-aid to me. What I would like to see is a process of support/teaching that must be implemented first, with a prescription for formula in the end if there is a need. Wishful thinking, I am sure.

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    1. Studies show that pre-pregnancy intention is a huge factor in breastfeeding success.

      Thank you for your comment. Education, encouragement, and support for breastfeeding need to start well before mom gives birth, and should continue well after.

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    2. Yes. Great great comment. Education & support. Figure out exactly WHEN and WHY women give up bf-ing (rates are I think 90% in the hospital, but dwindle quickly) and address THOSE issues. I really think it was lack of knowledge & support that led me to stop bf-ing my first child around 3 weeks of age, not the formula samples I got from the hospital. The second time around I had the same issues but I was able to get a lactation consultant to come to my house & help me, explain to me that this was common & didn't mean that I 'couldn't' nurse, and then provide ongoing support via phone/text...without that help I wouldn't have stuck with it. The formula sample is still sitting in my cabinet this time.

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  15. I should add of course that all of these thing could be implemented so long as the mother wants to breastfeed. Ultimately it's the mother's choice.

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  16. Breast feeding is very hard work and need to be "taught" by experienced personnel and the first few days after birth are especially critical. My wife and I did our fair share of delivery-suite, neonatal wards etc. through medschool, have seen many breast-feeding mothers (my wife is now a breast radiologist) but when it was our turn, we found it extremely "un-natural" and not as easy as one would hope. Several senior midwives and nurses tried to help us but it was not until one very experienced "lactational consultant" who could really detect the multitude of issue/problems there were before both the mother and baby were completely happy. One would presume that evolution have perfected breast-feeding but perhaps the changing role of mothers in the western society have stopped this cultural learning. For instance, I was amazed at how the lactational consultant could palpate an already engorged and painful breast and point out which quadrant it needed to be further drained (without an ultrasound probe!).

    Our little girl is 1 and still breastfeeding. My wife went back to part-time work at 3 months and had to find a private practice with radiologist who could cover her while she pumped milk. Breast-feeding also took a terrible toll on her sleep (Humans breast milk contents favor contact-feeding, can google all mammal breast milk contents for more info on contact feeding), but looking at them lying next to me while typing this on my iPad, I sincerely believe that all this suffering is well worth it.

    Most mothers would rather breast feed if they could, and "banning" formula is a rather dubious way to encourage it.

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  17. I definitely agree that this initiative goes too far and that a better method would be to have all state/ federally funded hospitals become certified as "Baby Friendly" per the World Health Organization standards. Most women choose to breastfeed in the prenatal period, and as a Physician I definitely think we as Health Professionals must do a better job supporting and promoting breastfeeding. It is important to public health and the quality of life of our Little Ones. Our country unfortunately continues to be very far behind with regards to pro-family and pro-breastfeeding work policies.

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  18. Sorry to open this debate after it's slowed down, but since this is a MiM blog, I figured that some data would be helpful:

    http://pediatrics.aappublications.org/content/early/2012/05/29/peds.2011-3633.full.pdf

    "Most mothers who want to exclusively breastfeed intend to do so for >3 months, but the majority are not meeting their intended duration. Mothers are more likely to achieve their intended duration when their infant is not supplemented in the hospital...After adjustment for all other hospital
    practices, only not receiving supplemental feedings remained significant(adjusted odds ratio = 2.3, 95% confidence interval = 1.8, 3.1)."

    So formula supplementation in the hospital is not only important, it's one of the most scientifically robust reasons for decreased duration of breastfeeding, even when the woman would like to continue.

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  19. Oh for pity's sake! I have adult children. I breastfed them. BUT #1 was not growing well according to her doctor, so we SUPPLEMENTED BFeeding with some formula.
    And for both babies, neither would take Bmilk from their father, but would suck formula right down from him.
    Whatever happened to doing what is right for the kid instead of dogma?

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