Guest post: A Canadian perspective on breastfeeding support

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Shared anonymously by a reader.

Before my son was born, I decided it would be unwise to be narrow-minded in my parenting choices. This decision was based on anecdotes I heard from friends and family who cautioned that each infant is unique and that the ways in which we meet each child’s needs are situationally-dependent. While I had every intention of exclusively breastfeeding in the first six months of my baby’s life, I was also open to the possibility of having to supplement with formula or to exclusively formula feed in the event there were variables outside my control such as low milk production or the inability of my baby to latch.

“I am asking the Ottawa health community to practice sensitivity in dealing with postpartum mothers when it comes to infant feeding.”

My husband and I were at peace with that decision, thinking that nourishing our child was paramount to any marginal benefits associated with exclusive breastfeeding.

While still pregnant, I had attended a public health information session on breastfeeding. I left the session disappointed. The speaker clearly demonstrated a bias in favour of epidural-free births conducted in homes or birthing centres rather than in hospitals, and she barely entertained the notion that some women might not be able to breastfeed. When I asked about the possibility of combining formula feeding with nursing, I was told that “we’re unsure what happens to the gut when formula is introduced” and that if we have issues with nursing, we “can’t say there isn’t any support out there” given the innumerable clinics and individuals that offer lactation assistance in the Ottawa area.

I discovered that this was at least partially true: there is a lot of support out there for women experiencing difficulty with nursing, but the quality of that support varies wildly.

My son was born a healthy weight at 8 lbs 7 ounces. He latched immediately, and nurses declared that it was perfect. I was also producing colostrum, the first type of milk a mother produces in the early days of their child’s life. While he lost almost 10 percent of his weight in the first few days, he quickly regained a substantial portion of that weight once my milk fully came in. At his five-day check-up, I asked a nurse about potentially needing to supplement with formula, and she responded that there would be absolutely no need given his great gains over the past couple days.

However, days passed, and my anxiety began to creep as he cluster fed regularly. I soon discovered, after weighing him on a kitchen scale and then promptly bringing him to my doctor’s office, that he was failing to gain grams on a day-to-day basis. By two weeks of age, he was not yet at his original birth weight.

Distraught, I visited my doctor’s office numerous times, only to be told that given my baby was not losing weight and did not appear languid, that it was not a cause for concern. My doctor did suggest that if I was still worried, to mix some powdered formula in with pumped breast milk, although the goal would be to stop any type of formula supplementation once we were satisfied with his weight gain.

I also received advice from three different lactation consultants, all of whom gave me differing opinions:

One stated that there was no need to worry given he otherwise appeared healthy and cautioned against feeding him “garbage formula.”

Another told me that he needed to gain weight but vehemently opposed giving him formula, stating my only viable options were pumped breast milk or donor milk.

Another was far less judgmental, suggesting I bottle feed him pumped milk four times a day in addition to nursing, but that formula was an option if I was struggling. She also suggested that my son’s tongue-tie be released, as it was likely impeding his ability to nurse effectively.

Others, including my doctor, opposed the procedure, unconvinced that it was the culprit. In the end, my husband and I opted for it as we thought it was for the best. We’re still unsure if it was the right decision given the discomfort our son endured. We’re also unclear as to whether it truly had a positive impact on his ability to nurse effectively.

Despite having originally been open to formula feeding, I suddenly found myself confused by the varying opinions, and began to feel guilty that I was letting my son down by not giving him “the best start in life.” The rational side of me was overtaken by anxious thoughts, fueled by the fear-mongering on the internet that suggested formula was anathema and would render my child deficient. These feelings were compounded by both the subtle and overt comments made by healthcare professionals whose advice I sought.

It was only after a particularly distressing visit to the doctor’s office where my son lay screaming in hunger as we tried to weigh him that I broke down. After discussing it with my husband, who saw me struggle with pumping multiple times a day and witnessed a particularly nasty spell of engorgement, we decided that supplementing with formula was completely reasonable and that, as supported by scientifically-based studies, our son would be fine. More importantly, it relieved an enormous pressure I had felt since the feeding issues began.

I came full circle to my original intention; however what I had truly been ill prepared for was the emotional strain of external factors, namely the judgment of healthcare workers who professed to support, but in fact undermined my confidence as a parent.

I have heard countless stories from women in the Ottawa area about their struggles with the lactation support community. One woman had virtually no milk and despite “trying her hardest,” couldn’t produce enough for her child to thrive. Another friend felt shamed and patronized by a lactation consultant after a very traumatic birth experience in which her child was placed in the neonatal intensive care unit and she was expected to pump despite her terrible ordeal. Another spoke about her prenatal class in which the instructor informed them that she would not be covering formula feeding in the course and passed out “statistics” regarding the cost savings associated with breastfeeding versus formula. This instructor clearly never took into account the possibility of having to rent a breast pump for 6 months, hire in-home sessions with lactation consultants, not to mention the various costs associated with maternal mental health deterioration.

After reading the scientific literature and consulting the data, I am certain there are benefits to breastfeeding, but that those benefits are marginal and should not trump a woman’s reasons for wanting to use formula whether it’s because she must or because she wants to. What is most important for a healthy, thriving baby is a healthy, thriving mother who feels empowered to make choices and be supported in those choices.

I am still nursing my son who is now a happy eight month old. I also still supplement with formula when I sense he needs it. We still don’t know why he wasn’t able to nurse effectively in those first few weeks, but at the end of the day, it doesn’t really matter why. What matters is that he’s properly fed and cared for by his loving parents.

There was a time I was so discouraged with breastfeeding that I contemplated switching exclusively to formula. I’m glad I was able to continue to breastfeed, but it’s not because I think my son is better off than his formula fed peers; it’s because I was able to make a conscious choice to continue to breastfeed based on my son’s needs and mine.

In writing this piece, I am asking the Ottawa health community to practice sensitivity in dealing with postpartum mothers when it comes to infant feeding. While breastfeeding should absolutely be encouraged and supported, this should not come at the expense of shaming women who are struggling or who elect to use formula either as supplementation or exclusively. There are many paths to being a good parent. What matters most is the outcome.

In the end, I can say that my son is happy, thriving, and well-nourished and that I am enjoying motherhood. Before doling out advice on feeding methods to vulnerable new mothers, it might be worth asking oneself whether that advice will lead to the outcome I am now grateful to experience.

  • Sue

    Thank you for this post.

    Reading through the narrative, I have a sense of post-partum depression, manifested by intense anxiety. This is illustrated in comments such as “weighing him on a kitchen scale and then promptly bringing him to my doctor’s office” and “he was failing to gain grams on a day-to-day basis.”

    This intense focus on “is my baby OK?” is part of a syndrome driven by the ideology presented as so-called “education” sessions that imply that using formula is “harming” a baby. However, we are more vulnerable to this ideology, and the sense of judgement, if we are already anxious, either through PPD, or a personality and life that is used to control and being correct, or some combination of the two.

    I sense that this brave lady needed emotional/psychological support for herself, not just infant feeding.

  • MaineJen

    Well written!! Thank you for this. The ‘breast is best’ rhetoric is getting ridiculous. Fed is best.

  • Lancelot Gobbo

    Dogmatic ideology triumphs over common sense in so many areas these days. I’m glad things eventually turned out well for your son, but it should have been sorted out more quickly if poorly-trained idiots had not stuck to recommending things that plainly were not working.
    A comment on ‘tongue-tie’ – I went to med school on the UK and did a GP residency there for three years. ‘Tongue-tie’ was mentioned once, in passing, as a discredited piece of old-fashioned nonsense. I was surprised on coming to Canada by to be asked about it quite often, usually in the context of speech delay, but in later years as a potential cure-all for nursing problems. I could not see anything unusual with the frenulum (the one under the tongue! Get out of the gutter!) and did my best to dissuade parents from seeking this unnecessary surgery. It’s function as a diagnosis along with it’s surgical release seem to be just another way of placing an obstacle in the way of a mother who asks about switching to formula, on the grounds that any action that keeps her nursing is a good action and perhaps by the time the babe has undergone this unpleasant procedure the mother will be over her temporary insanity and will not resist further exclusive breast feeding. Dogma and ideology – far more important than an infant’s pain, surgical risk, and nutritional status to some, it would seem.

    • demodocus

      I didn’t remember there were any below the neck. I can say that even with his impressive lip tie, kid1 got plenty of milk in without much problem, and later when he ripped it trying to eat an apple (Kid1 is notorious about his love of apples), nursing still hurt just as much to me.

    • Sue

      The pathologisation of “tongue tie” seems to have coincided with the increasing ideology around feeding methods. Cos, of course, there must be a REASON that can be fixed, since EVERYONE should be able to BF, right? (sarcasm font)

  • Emilie Bishop

    Your description of Ottawa sounds a lot like my experience in greater Seattle at a BFHI facility. I’ve heard Vancouver-area hospitals can be similar as well, and I think it speaks more to the culture of the BFHI than any particular physical location. I am beyond frustrated that so many places put breastfeeding before well-being. Truly a breach of medical ethics and common decency, no matter where it happens.

    • Allie

      Vancouver, WA or BC? In my experience in BC, there was bit of nonsense/woo, but not too much. We were in hospital 2 nights and 3 days. The nurses didn’t say much the first couple of days as we struggled to latch, my milk hadn’t come in, and LO was jaundiced (though not with levels that required treatment, and she was pooping like pro). On day 3, an eminently sensible nurse (for whom I will be forever grateful) took one look at her and said “why don’t you give her some formula? I’ll go get it.” We supplemented for 5 or 6 days, then I went on to breastfeed for damn near 2 years (never planned it that long, but for various reasons unique to us, that’s just how it went down). Seriously, supplementing is no big deal. Not sure why it’s not actively encouraged by lactation consultants.

  • yentavegan

    When I stopped ignoring the mounting evidence that laid before me and began to acknowledge that many parents successfully nourish their infants by combo-feeding ( formula and breastfeeding) and that combo feeding is a healthy choice that works more often than not I began to hear in voices of the mothers who were seeking my input, relief. Relief, because combo-feeding mothers can call themselves successful breastfeeders. Breastfeeding and breastmilk is not an all or nothing behavior.

    • MaineJen

      Yes!! Thank you. Especially for working mothers, combo feeding is an ideal solution. I enjoyed breastfeeding, and I sent pumped breast milk with my kids whenever I could, but it was good to know there was a can of formula our provider could break out when my supply fell short.

    • Christy

      We combo fed for the first six months and it was glorious. I wish this were presented as a valid option to all new parents!

  • Young CC Prof

    Here’s the problem with lactation consultants, and it’s certainly not unique to Ottawa: They really love breastfeeding.

    That may sound innocuous, or even obvious. I mean, pediatricians love kids, right? But no. Imagine realizing that a doctor is in love with a particular treatment method that might no be right for everyone. If you had knee pain, would you want to see an orthopedic surgeon who loved surgery so much he recommended it for every patient, or would you want one who presented your options in a balanced way, and let you know whether there were conservative treatments you could try first?

    They love breastfeeding intensely, and, thanks to a large body of literature that’s never heard of a socioeconomic confounder, they have a wildly distorted idea of the benefits. As a result, they push all women to breastfeed, even ones who don’t necessarily want to, even ones who really shouldn’t, even, sometimes, when the baby is in urgent need of food and nursing isn’t working.

    • swbarnes2

      In NCB-land…

      “Of course you love breastfeeding, how could you not? How could you love breastfeeding and not push it on everyone?

      That large teaching hospital with the top tier NICU sure has a lot of C-sections. They must love C-sections, which is very scary and unsafe”

      • FormerPhysicist

        My last OB loved surgery. She acknowledged that, and did it only when warranted. And did a damn fine job. There are parts of my job that I enjoy more than others, too.

        I think it’s scariest when professionals don’t acknowledge their own bias, because then they can’t guard against that bias.

        • Roadstergal

          I think you hit the nail on the head. It’s not that they have a bias towards breastfeeding – it’s that they don’t admit it to themselves, and/or don’t allow that this bias is something to be resisted.
          I have an ortho who loves surgery, and she is SO good at it. I would be hesitant to have anyone else cut on me now that I’ve seen how good she is. But she knows that surgery is just one option that has its place, and she’ll never do surgery without good reason.
          And it makes her outcomes better, because it’s surgery only when surgery is most appropriate.
          Similarly, LCs would do better if, like Yenta, they saw BF as just one option in a constellation of options, all of which need to be on the table for the best outcomes.

          • BeatriceC

            My boys’ orthopedic surgeons are like that. I moved to San Diego in large part for the hip/leg surgeon. He’s incredible. The hand/wrist/arm guy is amazing as well. Thankfully I’ve never had to see the spinal surgeon’s OR work, but he’s awesome in the office as well. They all love surgery. They are all extremely good. But they never rush straight into surgery. When they say “we need to do this”, I don’t question them. That’s about half of the surgery the boys have had the last few years. The other half has been “well, we could go after that one. What do you think”, and they let the boys decide which way they want to go with treatment. Their surgeons have been teaching them how to listen to their bodies’ cues and weigh the pros and cons and make their own choices based off the medical evidence. Have I mentioned I love their doctors?

      • Merrie

        If I had to have some sort of surgery, I can definitely see advantages to having a practitioner who enjoys performing the surgery.

        • Azuran

          The whole thing is really a stupid argument. Just because an OB happens to love the surgical part of her job, doesn’t mean that she’s going to push it when it’s not necessary.
          I’m with you, If I need surgery I’d much rather have someone who loves surgery than someone who doesn’t like it.
          And if anything, the opposite is actually much more likely: That someone who doesn’t like or hate surgery is more likely to try to avoid it longer than he should.

          In general, I love surgery, but there are a few kind of surgery that I really don’t like. I’ve never pushed (or even thought about pushing) for a surgery I like doing while it was not medically necessary. But more than once, while I was in the middle of a hard surgery that I don’t like doing, I’ve asked out loud why I just had to be a good, honest vet and recommend this damn surgery.

          • The Bofa on the Sofa

            Just because an OB happens to love the surgical part of her job, doesn’t mean that she’s going to push it when it’s not necessary.

            I don’t know if it’s that simple. We’ve talked about this before, how, one of the factors that has led to the increase in the rate of c-sections is that c-sections can now be done a lot more effectively – less risk, better technique, etc. Consequently, improved outcomes for c-sections changes the tipping point for where they should be done. I could imagine, then, that a doctor who is really good at surgery would be more likely to recommend a c-section in a situation where there is a choice to be made, whereas someone who is not as good at surgery would not do it.

            Then again, it’s not like there is anything wrong with that. I mean, if the reason you are doing a c-section is because it is better than the alternative, then what’s the problem? Nothing, of course. Unless, of course, you define c-section as bad, regardless.

          • Azuran

            Definitely the moment when a surgical procedure becomes less risky can vary between provider and hospital.
            At any point, if a c-section is safer than VB, the mother should be informed so she can make an informed decision. When that shift occurs can vary depending on the personal skills of each doctor at both c-section and handling of various VB emergencies and the risk factors of the patient.
            But that’s not the ‘Evil OB pushes C-section for no reason because he loves to cut women open’ thing that many people in the NCB community pretend that it is.

        • Young CC Prof

          Enjoy it enough to get very good at it, sure, that’s good. Elevate it above other treatment methods on the basis of weak evidence, no. That’s my issue with LCs, that they treat breastfeeding as inherently better for emotional reasons.

          If a patient’s knee pain resolves without surgery, a good surgeon will still be happy with the outcome, because the patient got better. If a mother is having a lot of trouble breastfeeding, and eventually resolves it with long-term combination feeding or even switching to formula, many LCs see it as a loss, even if mother and child are happy and thriving.

    • Busbus

      I agree with you. I wish there were a movement to introduce “feeding consultants” who will be happy to discuss and support you with all sorts of feeding options, be it exclusive breastfeeding, combo feeding, or formula feeding, and who will give mothers objective information on how one type can help another (such as formula supplementation until the milk comes in or until breastfeeding is going better). Even better would be a support movement of postpartum nurses who can do all of those things and will also come to mother’s homes to help with any and all maternal and baby concerns, including psychological support for the mother, without pushing any particular feeding method over another. And all of that routinely covered by health insurance/Medicaid. One can always dream, right…? 🙂

      • EmbraceYourInnerCrone

        Well in the U.S. if the Trumpcare Health bill (AHCA) gets stealth passed before Congress goes on vacation for the summer(beginning of July) there is going to be less support of Women’s health and maternity care then there is presently so that’s pretty much a pipe dream unfortunately:

        https://news.vice.com/story/trumpcare-is-a-disaster-for-womens-health

        “Pre-existing Conditions: Through an amendment to the AHCA introduced by Rep. Tom MacArthur of New Jersey, insurance companies could potentially make pricing decisions based on a person’s current health and medical history, just as insurers did before Obamacare. That means that depending on the state in which they live, women could once again be forced to pay higher rates because of so-called pre-existing conditions, which include sexual assault, C-sections, domestic abuse, pregnancy, and postpartum depression.”

        “Essential Health Benefits: Obamacare requires marketplace and Medicaid expansion program plans to cover 10 categories of care considered “essential health benefits.” Those include maternity and newborn care, mental health and substance abuse treatment, and preventative and wellness services. States could also waive the guarantee of coverage for these services under MacArthur’s amendment.”

        Nurses in many places are underpaid and over worked already. They can only care for so many patients at once before care suffers and things get missed.

    • Sue

      Good points, but it’s not ONLY that they love breastfeeding, it’s that promoting BF is what they see their skill as being.

      It’s a bit like “birthing” vs obstetrics – if you are skilled at all sorts of birth, you can give advice that suits the needs of the client, rather than just pushing “natural”

  • OttawaAlison

    So many of us have been fed up over the years with Ottawa’s Public Health tough stance on breastfeeding – formula feeding last I checked wasn’t even on its main mom and baby page – it was on food safety.

    I felt that they were looking down on me when I said I was supplementing at the well-baby clinics. One nurse was awesome and really thought it was no big deal to supplement – unfortunately not all of them were as understanding.

  • Mark

    Knowing what I know now.

    I would ask

    ‘What if despite all the consultations, my wife could not produce enough milk?’

    As for saying, we don’t know how formula effects the stomach, I would say yes we do, millions of babies were brought up on formula and are doing fine. I came here for objective advice and not propaganda and then walk right out.

    How patronizing.

    For the lactation consultant who suggested donor milk, I would suggest a quick course on infectious diseases. I would never trust someone else’s milk over formula. Particularly if is been bottled and stored. We don’t allow the sale of unpasteurized cows milk.

    How horrible.

    If I or anyone else is looking for medical advice, we want it to be objective as possible. Not someone’s opinion.

    Objective information based on the science. If after that, if someone wants to explain their ‘professional’ opinion then that’s fine.

    • FallsAngel

      WRT donor milk- In the US, milk from legitimate milk banks is extremely expensive and it’s usually used for hospitalized babies with specific problems. Dunno about Canada. Going rate seems to be $3 to $5 per ounce.
      http://pslmc.com/service/mothers-milk-bank-denver
      https://lactationmatters.org/2013/11/08/why-is-donor-milk-so-expensive/

      • Young CC Prof

        My personal opinion is that it is unethical to give safe screened donor milk to healthy babies as long as there are micropreemies or others with special requirements who don’t have access.

        • Mattie

          Same, although I guess it depends on stock levels?

          • Young CC Prof

            Sure, if we ever reached a point where there was enough to go around (by a method that did not involve impinging on anyone’s bodily autonomy), I’d be fine with it.

          • Kerlyssa

            dear god, flashbacks to the mother’s milk from Mad Max Fury Road

          • Roadstergal

            And as long as there was a 100% reliable and cheap way to screen for disease and nutritional content, IMO.

            I mean, sure, the risk of HIV or HCV or HBV or what have you might be very, very low with donor milk. It’s zero with formula. For preemies, until they fully replicate the NEC-risk-reducing effects of ideal mothers’ milk in formula, the low risk is worth it, but for a term infant? (I know many moms do it, I just don’t think it’s a sensible risk.)

      • DaisyGrrl

        There are four legit milk banks in Canada and that milk is prioritized for babies in NICUs. The OP in Ottawa would not have access to this milk.

        Health Canada does not recommend using donor milk from other sources, so I think that LC was out of line.
        http://www.hc-sc.gc.ca/fn-an/nutrition/infant-nourisson/human-milk-don-lait-maternel-eng.php

        • FallsAngel

          Good to know!

  • Gretta

    I suceesfully nursed for over a year with all three of my boys and supplemented with formula when I felt they needed it. They were also losing weight and I didn’t heaitate. They are all healthy big kids now and rarely sick. They are all doing great in school. None of them are obese.

    Stop the madness.

  • Sheven

    I’m sorry you had such a difficult and confusing time. Thanks for letting us understand how vulnerable and disorienting it is to get so much conflicting health information after going through childbirth and figuring things out as a new parent. Congratulations on your healthy and happy child!

  • K Esta

    I gave birth to my son in Ottawa (Aug 2015) and experienced similar pressure. It had me doubting myself when I’d previously thought I would give breastfeeding a try and switch to formula if there was any trouble. I knew a lot of people felt strongly about breastfeeding, but I didn’t think it was a big deal either way. Turns out the breastfeeding culture had seeped into my mind more than I realized.

    I wasn’t prepared for the utter lack of confidence I would feel postpartum. All my good sense was gone and my defenses were down. Between the nurse who showed up at my bedside with a pump I never asked for and every nurse or doctor who came in the room asking if I had talked, or would like to talk, to the lactation consultant I lost all sight of my own thoughts and goals. They must know better than me, right?

    Then the second time we were readmitted to the hospital for Bili-light treatment (so overnight stay number three total), my son had lost more than 10% of his birth weight and formula was shoved at us. Because what a jaundiced baby really needs is fluids.

    I didn’t know that. All I could think, but was too exhausted and confused to
    say, was ‘why didn’t anyone say anything two days ago?!’ I would have given him formula in a heartbeat.

    For the next three months every feeding discussion at every well-baby visit and weight check came with the assumption my goal was to get off the formula and exclusively breastfeed as soon as possible. I tried, but never got there. By three months the constant anxiety over whether he was getting enough was crushing me and we switched to all formula. I don’t regret that decision, but I had enormous doubt and guilt at the time. If anything I wish I’d done it sooner. I don’t know if my son really needed the formula. He was gaining well and, looking back at pictures, he was fat and healthy, but the anxiety kept me from enjoying my baby as much as I could have.

    • fishcake

      I feel like I was in a similar situation. Thought I planned ahead to be flexible about feeding, but then felt the pressure post-partum when I felt so vulnerable and unsure of myself. I had thought I was a fully grown woman, but the way I was treated…. Still trying to gain all my self-confidence back, though I am doing pretty good now. I hope you’re well too.

      • guest

        I felt the same way too. I was going to give breastfeeding a shot and switch to formula if it didn’t work out. The stress of not knowing if my son was getting any milk was enough for me to give up breastfeeding when I started supplementing. I also felt like when I brought up any concern about my child, it was brushed off as a first time mother over reacting, which made me question myself a lot. 6 years and 2 kids in and I still feel like any time I bring up a concern, I am over reacting.

    • Christy

      I’m so sorry you had that experience. I, too, went into the labor and delivery ward with the intention to keep my options open as far as feeding my little guy. We did end up supplementing due to his hypoglycemia but not everyone was happy about it and I definitely felt the pressure to go to exclusive breastmilk as soon as possible. I think if I hadn’t been following this page for so long, it would have been much, much harder to feel confident that my baby would be just fine with combo feeding.

      • EmbraceYourInnerCrone

        What is it with the “Exclusively breastmilk” I honestly do not understand. With formula someone else can feed the baby while the mom recovers. With formula you don’t have to spend hours pumping if you work outside the home, and maek sure you take a cooler everywhere to store the breast milk. Yes with formula you have to bring along or have access to clean water if you are using powder or you have to be able to use ready to feed (I economized in a lot of other areas and was able to buy at the PX so I was able to use Ready to Feed, I realize not everyone can do that)

        What *magic* is available in breast milk that makes it better? Was I a crappy mother because I exclusively formula fed (because I f’ing wanted to) and went to work when she was 6 weeks old? Will my daughter be stupider because I did not breatfeed? Will my daughter never love me because I didn’t breatfeed? Do kids just not love their dads as much?(or their adoptive parents or foster parents) because dads cant’ breastfeed?? If I have to hear Breast is Best one more time I’m going to throw something. Best for whom? Best exactly how?

        • Christy

          Exactly! My kid thrived on being combo fed and then switching exclusively to formula. He loves going to day care and playing with his friends all day! I read what some of the “experts” write and I wonder where is this sad, sickly, lonely, dull child that I should have as a result of my selfish choices?

        • MaineJen

          But gut bacteria!!!1! Attachment! Magical birth sparkles!!!
          …or something IDK

        • Young CC Prof

          A few decades ago, the World Health Organization became concerned about babies, especially newborns, being supplemented with unsuitable or contaminated foods, and campaigned for breastmilk only to prevent babies from dying of diarrhea.

          Then, mostly in the 90s, some self-righteous nuts took those recommendations out of context, misinterpreted some findings related to gut bacteria, and the drive to absolutely exclusive breastfeeding was born. It probably had little effect on the rates of predominate breastfeeding, but drove a lot of mothers to quit entirely who might have been happy combo-feeding if they had been supported and taught how to combo-feed successfully.

          • EmbraceYourInnerCrone

            Looks like a good idea(safe infant feeding in third world countries), taken to ridiculous lengths in first world countries where it doesn’t usually apply (it’s very often not feasible for a poor mother first world mother who has to work to breastfeed or pump, so instruction in the hospital about safe infant formula feeding-Don’t water down powdered formula,etc is much more helpful than “Breast is Best!!!eleventy!”
            If you work long hours, or work 2 part time minimum wage jobs and take the buss every where, dragging a pump and cooler everywhere may not be feasible, you also may not get paid for the time you need to take to pump.

            Kind of like the C-section “recommended rates” that the WHO literally pulled out of thin air

  • JDM

    I may have missed this if it was discussed before, but I wonder what differences women find in the kind of advice in most western European countries compared to the US and Canada. (I did read that excellent account of the French birth experience.) What makes me wonder is that in the US and Canada we tend to go all in for whatever position we have concerning diet. Right off to the extremes in whatever direction we are headed. It seems in Europe that doesn’t happen so much.

    Seems to me that’s what gets described here so often with lactation advocates. Those advocating it don’t just help and stay moderate but instead tend toward the extremes. This is made worse because there are real extremists involved in the movement, but I suspect part of it is just that once we start advocating anything involving diet, we forget the “moderation in all things, and moderation in that” part. That seems to be what the woman above found, so much so she began to doubt her previously figured out, and quite sensible, position.

    • Mila Bacchini

      I gave birth last month in an Italian “baby friendly” hospital – no well baby nursery at all, 24/7 rooming in, focus on breastfeeding.
      Still, when I called the midwife on duty at 4 am the first night, so tired from four hours straight trying to nurse my crying daughter that I was falling asleep with her in my arms and visibly upset, she just proposed, then brought me a tiny supplement. My baby was happily sleeping in thirty seconds after eating just half of that and no one shamed me about it.
      Incidentally, we did not need more formula up to now, and we are completely comfortable with exclusive breastfeeding, but I’m so glad I did not have to suffer any shaming just for being exhausted.

      (Sorry for my shaky English!)

      • Heidi_storage

        I’m glad the nurse was compassionate. No need to apologize for your English; your statement was perfectly clear and coherent, much more so than the writing of some of our commenters whose first language is English.

      • demodocus

        Congrats! I’m glad your midwife had good sense and that your baby is fine now. 🙂 (Your English is better than many of native speakers I could mention.)

      • BeatriceC

        Yeah, I’m with demodocus. Your English is just fine, and better than a huge number of native speakers.

        Your experience brings up something I’ve been wondering. We know exhaustion can cause issues with supply. I’m wondering if perhaps the incidence of delayed lactogenesis is growing because of the insistence on not allowing the mother to rest and no pre-lacteal feeds adding to her normal post-childbirth exhaustion and stress. I’d be interested in seeing a comparison of the rates of delayed lactogenesis among women who have generous support, sufficient rest, and access to supplementation when wanted/necessary vs women who are deprived of the opportunity to rest and recover and lack access (or willingness, in some cases) to supplemental formula.

        • Young CC Prof

          Well, we know that offering a few cc’s of formula after every feed at the first sign of excessive weight loss results in a higher rate of long-term breastfeeding success (that study that sent the entire lactation community into a debunking panic, although none had anything to debunk it with).

          I’d really like to see one that looked specifically at maternal well-being.

          It’s clear that severe maternal exhaustion is a risk factor for medical emergencies related to insufficient milk intake, no studies but that’s a common theme that emerges over and over again, that, for example, the mother went several days with only a few minutes of sleep. The extreme and dangerous sleep deprivation then prevents the mother from recognizing that something is wrong with the baby and what the professionals are telling her makes no sense until the situation deteriorates further. Then, a baby who would have been fine with a bottle of formula requires three days in intensive care, never re-establishes nursing, and can suffer lasting consequences.

    • Quende

      I gave birth in a Czech hospital in Prague, certified as “baby friendly”. When I first started reading this blog I was shocked by the description of BFHI hospitals in the UK and US, as it was very different from my experience. I had a retained placenta, general anesthesia and some significant blood loss, which made me dizzy and prone to fainting for the next two days. The idea that I would be required to look after a newborn in such a state is horrifying. The baby was kept in a nursery and brought to me for nursing seven times a day until I recovered from the worst, and then I was ASKED if I felt up to rooming in with my baby.

      The rooming-in rooms were all equipped by a precise baby scale and mothers were required to weigh the baby before and after each nursing and write the amount into a sheet (wet diapers and stools were also recorded). This was very fortunate since I had delayed lactogenesis (no milk or colostrum until day five, and even after that I produced very little). The hospital’s policy was to wait until 10% weight loss to offer supplementation, but when I asked for formula the second day when I learned the baby lost 7%, it was brought to me with no fuss (the formula was provided by the hospital).

      There was a general expectation to breastfeed, certainly I was not asked about my feeding preferences, but at least I was not shamed for my lack of milk and my baby’s health was not endangered. Thanks to the weighed feedings, everybody knew that I really had zero milk and there were none of these horrible psychological headgames I read about in other women’s experiences here. So apparently, the BFHI certification does not REQUIRE hospitals to adopt such cruel and dangerous policies.

    • JDM

      Thank you for those first-person accounts. It’s always interesting to hear what’s happening elsewhere and how things like this are handled. (And Mila Bacchini, let me add to those who already pointed out your English language skills are very good. I wouldn’t have known you didn’t speak English as your first language if you hadn’t said so.)