Lactation professionals and the medicalization of infant feeding

Pump breastmilk by Autimatic machine

You might think — I always have — that childbirth is about the birth of a healthy baby to a healthy mother. But according to many midwives, that isn’t enough. A mother’s birth experience is deemed critical and the experience is apparently ruined by technological interventions. Hence the dangerous campaigns for “normal birth,” defined as birth without any interventions, any machines or any surgery.

Indeed, midwives wax lyrical on the subject of the medicalization of childbirth, forcefully arguing that most babies would be fine without intervention of any kind, insisting that doctors have medicalized childbirth for their own benefit, and claiming that doctors cause emergencies so they can heroically step in and “save” their patients.

Lactation professionals have created breastfeeding “emergencies” from which they heroically “save” babies. But most of these emergencies have been caused by lactation professionals themselves.

Clearly, medicalization is a very, very bad thing … until it comes to infant feeding. With infant feeding medicalization isn’t just awesome, it is absolutely necessary.

You might think — I always have — that infant feeding is about providing a developmentally and nutritionally appropriate food resulting in a healthy baby and a healthy mother. But according to lactation professionals, that isn’t enough. Trivial benefits and fabricated benefits are deemed critical to infants who are apparently ruined by formula. And any intervention, no matter how artificial, burdensome or technological — including surgery on babies — is not merely justified, but necessary. The mother’s breastfeeding experience? That’s irrelevant!

But I’m here to tell you that the medicalization of infant feeding is harming babies and mothers. We KNOW, though generations of experience involving millions of babies, that term infants will be healthy on formula. And I have come to believe that lactation professionals have medicalized infant feeding for their own benefit, creating feeding “emergencies” so that they can heroically step in and “save” patients breastfeeding.

Wait, don’t lactation professionals say that breastfeeding must be best because it is natural? Don’t they demonize formula because it is technological?

Yes, they say that, but their behavior belies their rhetoric.

First, breastfeeding is apparently a bodily function that is outside the natural realm of other bodily functions, all of which have failure rates. Most women won’t conceive the first month they try to become pregnant; up to 20% of established pregnancies end in miscarriage. Breastfeeding, too, has a natural failure rate: up to 15% of first time mothers will not be able to produce enough milk to fully nourish an infant, especially in the first few days after birth. Some babies are incapable of fully draining the breast. Furthermore, just as some pregnancies aren’t wanted and will be terminated, some women have no desire to breastfeed.

But not according to lactation professionals. To hear them tell it, breastfeeding is perfectly designed for every mother and every baby and failures rates are exceeding low. Moreover, all good mothers want to breastfeed; only inferior, lazy women who are dupes of the formula industry and lack lactation support would ever consider formula.

Second, the process of infant feeding itself has been medicalized. For most of human history, infant feeding involved giving infants food so they could grow. In our contemporary culture — with its twin emphases on intensive mothering and reducing risks — breastfeeding has recently acquired all sorts of medical benefits ranging from the trivial (8% fewer colds and 8% fewer episodes of diarrheal illness across the entire population of infants in their first year), to major “benefits” (supposedly increased IQ, decreased risk of allergic disease, improved long term health), all of which disappear when socio-economic status is taken into account. Therefore, ever more arcane, highly technological benefits are dreamed up like a “better” microbiome or “better” epigenetics for which there is only speculation and no actual evidence at all.

Third, any and all technology, no matter how invasive, is embraced if it results in more women breastfeeding for longer.

Don’t produce enough breastmilk to fully nourish your baby? Pump after every feeding with an electric pump whose plastic parts are strapped to your body! Take drugs like domperidone!

Baby having trouble extracting milk from the breast? Tape a plastic Supplemental Nutrition System (SNS) to your nipple in order to feed the milk that you pumped! Or perform surgery on the baby’s tongue!

And above all, pay money to a lactation professional who will press all sorts of unnatural interventions on you so you can “naturally” breastfeed.

I’m reminded of the paper by anthropologist Margaret MacDonald in the Lancet entitled The cultural evolution of natural birth:

Natural birth has long held iconic status within midwifery and alternative birth movements around the world that have sought to challenge the dominance of biomedicine and the medicalisation of childbirth…

But there’s is nothing natural about waterbirth, listening the fetal heart with a Pinard stethoscope or recommending chiropractic. Yet midwives do it anyway. Why?

[If an intervention] can bring back the clinical normalcy of the labour pattern and keep it WITHIN THE MIDWIFERY SCOPE OF PRACTICE, it is generally regarded as a good thing by midwives and clients alike … (my emphasis)

The same thing is true about lactation professionals. ANYTHING is acceptable as long as it can keep the women breastfeeding and within lactation consultants’ scope of practice. Lactation professionals have created breastfeeding “emergencies” from which they heroically “save” babies. But most of these emergencies have been caused by lactation professionals themselves with their relentless pressure to breastfeed. They could easily be solved, or avoided altogether, by feeding babies formula.

In truth, the scientific evidence tells us that breastfeeding is a lifestyle choice, NOT a health choice. We know that because breastfeeding rates have no impact on infant mortality and major causes of infant morbidity. We know that because nearly two entire generations of Americans were raised on formula and every possible parameter of infant health improved during that time.

But in their relentless effort to claw market share from formula companies, lactation professionals have medicalized infant feeding by claiming a perfection of breastfeeding that doesn’t exist, medical benefits for breastfeeding that don’t exist, and by creating medical emergencies that they caused.

That’s why we should stop medicalizing infant feeding and return it to its unhindered state. Above all, we must end intrusive breastfeeding promotion in hospitals. It is harming infants’ physical health (exclusive breastfeeding is now the leading cause of newborn hospital readmission) and mothers’ mental health.

Let MOTHERS decide what’s best for babies, their families and themselves, NOT lactation professionals.

  • yentavegan

    OT…Dr. A is there a possible correlation between long term use of birth control pills ( 10 plus years) and subsequent inability to produce ample breastmilk? Has a study been done?

    • Cristina

      I don’t think anything good could come out of that study, honestly. I can see women being refused the pill because “they may want to breastfeed one day.”

      • Heidi

        Yeah, that and the fact many women who take birth control do so for issues like PCOS, who are more likely to have issues with breastfeeding.

  • guest

    I have noticed that the majority of midwives and “lactation consultants” are not themselves mothers. In that they have never carried, birthed, or raised a child.
    The clinic I currently work at works with 20+ LCs, midwives, and doulas to offer support to pregnant patients. None of them have kids, or have experienced pregnancy. Not one.

    In contrast, nearly every female OBGYN I have worked with has raised children, in spite of the heavy demands placed on them by their careers.

    I’m not trying to question any person’s reproductive choices, but rather their career choices. What would motivate somebody to become a golf coach if they had never played golf?

    I think there is a fascinating study in this somewhere. What motivates midwives and LCs to choose their career?

    • mabelcruet

      On UK TV, there is a show called ‘One Born Every Minute’, its a documentary series about midwives and births. The current teaser segment they are showing has a midwife saying ‘we’re birth addicts’. I’ve always found this an odd thing to say. I love my job and was very content in the work I did, but I don’t say ‘I’m an organ addict’. It sounds rather unprofessional to me, but it seems to go along with the whole general “gathering your baby’s soul from the stars and bring her earthside, lightly garnished with twinkly golden custom-blended breast-milk” atmosphere that is currently prevalent in midwife circles-they seem inordinately fond of using mystical imagery and overwrought emotional language (tweets like ‘it makes my heart sing’, ’embrace the miracle’, ‘spreading the magic’) and to me it’s just unprofessional. Maybe I’m just old and cynical.

      • The Bofa on the Sofa

        You are a pathologist. You aren’t normal.

        • mabelcruet

          I’m perfectly normal! Just because I guddle about in people’s innards…

          • I think you are 100% normal. I feel much as you do.

    • Merrie

      I attended a breastfeeding support group for a chunk of time and I really liked the IBCLC who led it. She was a mother of four herself (hers were older, I think the oldest ones were in college at this point), and very supportive of different feeding choices. Hopefully having a bunch of kids gives you a broader perspective on raising kids.

      • I tend to think that once one has one’s own family it’s much more difficult to be doctrinaire about choices. Each pregnancy is different, each birth is different, each child has a different personality and needs. And no one is ever exactly like the textbook.

    • Well, I worked for 12 years as a CNM without being either married or having children. Does giving birth and raising children change one’s perspective? Undoubtedly. But I don’t think that being single, or being the mother of a family is inherently “better” or “worse”. Just different.

  • AnnaD2013

    “Breastfeeding is a lifestyle choice, NOT a health choice.” Thank you for writing that; it is SO true!

  • mabelcruet

    OT, but Byrom and her twitterati fangirls have lobbied for a formula company to be banned from sponsoring a birth conference, and banned from exhibiting and having a stall at the conference (Lets Talk Birth 2019). So how does that square with her professed stance of ‘being there for ALL women’?

    Her tweet from Feb 21 states ‘NHS supports ALL womens choices w infant feeding. Presenting evidence based information important 4 all aspects of health care’. And yet, at a national conference tour, she is instrumental in banning formula providers from accessing midwives and other maternity professionals to provide information about formula feeding. This ensures that midwives are uneducated in this area and therefore likely to be biased in the information they provide, given that they are only trained about breast feeding.

    Blatant hypocrisy. Deceitful, deceptive and dishonest-she says one thing and immediately does the opposite. Utterly unprofessional, utterly unsupportive to women. She can post as many humble-brags as she wants about how wonderful she is, that doesn’t change the fact that she is a liar.

  • Gene

    Another birthing center disaster. The description of the birth is just brutal.

    https://www.heraldtribune.com/news/20190222/attempted-out-of-hospital-birth-takes-tragic-turn-for-new-parents/1

    • momofone

      “We were sold on this beautiful experience.”

      “She brought flowers, snacks, kombucha, coconut water and amethyst.”

      Of course you were, and of course she did. Heartbreaking and infuriating.

      • demodocus

        Kombucha is on my small list of foods I can’t even pretend to like

      • mabelcruet

        Amethyst. Because its well known for its neuroprotective and oxygenating powers and ability to regenerate dead and liquefying cerebral tissue.

      • RudyTooty

        It’s hideous. It never should have happened.

        Is anyone comforted to know that the owner of the Birth Center (NOT the same midwife who attended the birth), is on the Fetal and Infant Mortality Review Board for the Healthy Start Coalition of Sarasota County?

        I’m sure this case will be thoroughly reviewed and numerous negligent parties will be held accountable. /sarcasm

        Oh wait.

        Peer review:

        CPM peer reviewer: “Why did you choose to bring amethyst? Lepidolite and manganocalcite would have been more appropriate gem healing modalities considering the circumstances. What do you have to say for yourself?”

        CPM JS (under review): “Amethyst is all I had in my birth bag that day.”

        CPM on peer review committee mumbling among themselves.

        CPM peer-reviewer: “We have decided on a corrective course of action. CPM JS’s license is reprimanded and she is assigned 60 hours of remedial gemstone healing coursework which must be completed in the next 6 months, and through a gemstone-accredited program, after which her license will be reinstated to full practice authority.”

        • Amazed

          I am very comforted to know this about the centre owner. Very comforted indeed.

    • Cristina

      This hit me hard since he looks just like my youngest, who was also breech. He was born via C-section and is an incredibly precocious 5 year old.

      • Vast

        Weird! I was about to comment that it was spooky to me how much the baby looks like my son did! My son was footling breech, like this baby. Delivered safely by C-section. Also unusually precocious, soon to be five.

      • Marie

        Same here. My little redhead wasn’t breech but did have a sharp decline in heart rate during delivery. The hospital immediately started the stat section protocol but luckily he came out on the next push. He came out floppy but perked right back up and is 100% fine now. I was a multip with no complications up to that point. I can’t even imagine why someone would give birth more than 5 minutes away from an operating room!

    • Amazed

      Oh God. Correct me if I’m wrong but it seems to me that the entire freaking family KNEW there were problems with the birth centre and STILL went there. Now, they are sniveling that they were misled.

      I feel for the baby but I have zero compassion for the loons it did NOT luck out to be born to. In fact, I want to grab mom and slap dad with her stupid body. And then auntie, grandma, and the entire disgusting clan.

      They knew, they KNEW and they went there anyway. Loons.

      All of which doesn’t absolve the birth centre, of course. And the lack of control. But for this family, whining that they didn’t know is something that I obviously don’t buy. They didn’t know it would happen to THEM, that’s all.

      • rational thinker

        I have to agree with you and the grandmother was still trashing hospitals after they saved the babys life and I think she also put pressure on them to have out of hospital birth. Also I think the family is lying about a few things too. I wouldnt have anything bad to say normally about the go fund me except for one thing. The funds are also going to be used to reopen thier coffee shop, ok no FUCK YOUR COFFEE SHOP!!!!!

        • Amazed

          I don’t care for their coffee shop either but they will need money to take care of their baby IF he survives.

          They seem to have found each other just fine, the family thinking birth is just a huge picnic and the midwife who has educated herself on Instagram.

          The only party totally absolved of any wrongdoing in this fiasco is the poor sweet baby.

          • rational thinker

            The thing about the coffee shop is it sounded like they just locked the doors for a few weeks, so all they would have to do is unlock the doors and turn the lights on. Not build a new buisness from the ground up. Why do they need money for that? A family member or a friend or employee could have run the shop for awhile that is what seemed sketchy to me. Also I do think if the story is correct that the EMS screwed up bigtime and caused or played a big part in causing the brain damage. Why the hell did they stay there for thirty minuites? I have a lot of compassion for this baby but after baby that is where my compasssion ends.

          • Amazed

            I gave up on trying to understand what the EMS part was. I think it depends on which side of the story is true. If the mother herself gave mixed signals, they might have hesitated before loading her off in the ambulance. But I think fault lies more with the midwife. From my reading, she was quite aggressive in enforcing her model of “care”. I doubt it was the EMS’ idea to have her ride in the ambulance. However, they didn’t do enough to stop her. Perhaps they felt cowered, who knows? Unlike her, THEY know they can’t do a great breech birth to put at Instagram. Or they might have actually preferred to have the ‘skilled’ person in the ambulance? Who knows?

          • RudyTooty

            If that midwife was ready to load up her patient and get her to the hospital ASAP, EMS would have followed suit.

            Imagine if EMS arrived and the midwife said, “I’m so glad you’re here, we have to go NOW.”

            EMS arrived at 14:46.

            Even with her negligence and not diagnosing the breech presentation until pushing, they still had time to get the patient to the hospital.

            But not only was the midwife negligent. She was incompetent. She didn’t know what she didn’t know. She didn’t know she was dealing with a life-threatening complication. Because she’s a CPM, and incompetence is part of their training. She thought everything would be ‘just fine’ just like it is on fucking Instagram.

            https://www.documentcloud.org/documents/5746200-EMS-Report-Bean.html

          • Amazed

            Yes to all of this. What I’m saying isn’t that the midwife was competent. It’s clear that she wasn’t. What is still unclear is just how competent the EMS were.

          • RudyTooty

            EMS shouldn’t have been put in the position they were put in.

            What kind of LICENSED PROVIDER calls for emergency transfer, then when transport arrives says “hang on, we’ve got this.”

            According the news report, one of the EMTs argued with the midwife.

            ““The main EMT said, ‘She shouldn’t push. We need to go right now,’” Fisher [the father] said. “But Jordan [the midwife] said, ‘No, just push.’ The arguing went on for it seems like forever.””

          • Amazed

            Well, in the Gatehouse article there was this owner of a birthing centre who admitted she often called EMS and put them on hold – and saw nothing wrong with this. Because she was more experienced, you see. Personally, I fail to see just how much sense there is in calling someone over because yoy;re afraid your experience is not enough and then, instead of speeding to the hospital, you keep them waiting with the hope that you’re able to fix it. If you are, great. If you are not, someone dies or gets damaged. And that’s without taking into account the various OTHER emergencies that might need the EMS you’re keeping occupied and actionless.

          • RudyTooty

            The same birth center owner who serves on the Florida review board?

            Or a different one?

            What a racket.

          • Amazed

            I’m not sure. Either way, it’s not looking good.

          • RudyTooty

            Oh wow. This is rich.

            Pathways Birth center has been using this most recent negligent birth injury at Rosemary Birth House to as an opportunity to promote their own birth center services. (Go ahead, go check out the Pathways Birth center FB page.)

            But it appears that Pathways and Rosemary have the same practice protocol for calling EMS and then delaying transfer. (Quote from Gatehouse Media story).

            https://uploads.disquscdn.com/images/60891d30b835703baba0c02ad76d48dbdb5db91fa4855441c8e632370909f25e.jpg

          • rational thinker

            That shows their true colors. They are using this to get more clients that is fucking disgusting not to mention unethical.

          • rational thinker

            Yes the whole having EMS on hold thing really pisses me off they have no respect for other people. Then again home birthers are selfish to begin with so it is not really a surprise when the hold up EMS, which is ironic because aren’t you supposed to “trust birth”.

          • BeatriceC

            My son is completing his last term of fire-rescue training. One of his teachers speaks repeatedly about managing patients who are reluctant to go to the hospital. It’s a big enough issue that it’s worth the time spent teaching students how to manage such patients. I would not be surprised if the delay was because the mother didn’t want to transfer and had to be convinced to do so.

          • rational thinker

            I do think maybe the family is lying about a lot of things so maybe they were the ones who held ems up. As for the midwife she did call right when she realized it was breech so maybe they are blaming her for some things knowing people will believe them. Who knows if any of this will story will ever be sorted out I just hope that baby will be ok as he is the only innocent one in this whole mess.

          • RudyTooty

            The LM apparently called someone else BEFORE she dialed 911. Presumably that unknown person (I’m guessing the birth center owner), told the midwife to dial 911.

            DID YOU LISTEN TO THE 911 CALL? (There’s a link in the news story).

            You tell me if that LM thought there was any urgency or emergency happening.

            It’s not the patient’s job to know whether a medical emergency is happening – it’s the licensed provider’s job. That midwife did not know what she did not know.

            And FLORIDA gave her a license to do just what she did.

          • The Bofa on the Sofa

            When I read about this elsewhere, it was described that in her midwifery training where she was supposed to apprentice for whatever number of births, she was actually attending those births by herself.

            And it was also mentioned that she changed the due date ahead something like 9 days.

            Whoever taught her to be a midwife taught her well, didn’t they?

          • RudyTooty

            I read that, too. That her training was supposed to be supervised, but that didn’t always happen.

            I think her training was on par with every other CPM’s training.

          • The Bofa on the Sofa

            I don’t know enough to say it’s in par, but will say it doesn’t surprise me

          • rational thinker

            I did listen to it and no she did not express urgency and she probably did call her boss first. The part I don’t get is why did EMS stay there for 30 min. The only reason EMS would have sat there that long is if the patient denied transfer. I do think the parents are lying about a few things. As for the midwife she was new at this why the hell did her boss leave her by herself? The state should not give CPM license at all or paying the bill for one that does need to change.The baby probably would have been ok if EMS had left right away. I think parents are hiding something and trying to place all blame on birth center instead of taking their fair share of blame. Also I think grandma pressured this couple to use a midwife even after the hospital saves babys life she went right ahead trash talking hospitals for the article.There are a lot of people at fault here but the innocent one paid the price.

          • Desiree Scorcia

            My guess is they don’t have health insurance.

          • Daleth

            If you show up at a U.S. hospital in labor, you get to deliver there whether or not you have health insurance.

          • MainlyMom

            Yes, but they’re stuck with the bill and no way to pay. Hence the go fund me.

          • Daleth

            Yes, but they’re stuck with the bill and no way to pay

            …and so you don’t pay. And nothing happens, except maybe a slight hit to your credit score. What, did you think they would go to debtor’s prison? Or maybe the hospital would repo the baby (haha)?

            If you’re delivering a baby or you’re so sick or injured you think you might die, GO TO THE EMERGENCY ROOM whether or not you’re insured, whether or not you can afford it. They will treat you. If you can’t pay, don’t pay. Either you can work something out with them (US hospitals routinely reclassify lower-income patients as charity care if the patients reach out to them and ask), or you can just NOT PAY and take the slight, temporary hit to your credit report.

          • MaineJen

            It’s not a “slight, temporary hit.” Once something goes to collections, it’s on your credit report for 7 years. You can’t even rent an apartment any more without a good credit score.

            It’s very expensive to be poor in America.

            I’m not saying I condone home birth, but I do understand why a huge medical bill you KNOW you won’t be able to pay would give someone pause.

          • Daleth

            I’m not saying I condone home birth, but I do understand why a huge
            medical bill you KNOW you won’t be able to pay would give someone pause.

            It’s hard for me to see how someone who can’t afford to get into a long-term payment plan with a hospital can somehow afford $6000+ UP FRONT for a homebirth midwife.

            It’s not a “slight, temporary hit.”

            With unpaid hospital bills, you can usually work something out with the hospital (have them write part of it off) if you’re low-income and you call them. If you don’t call, and they report it (not all hospitals or the collection agencies they sell debt to even report medical debt), it’s still not going to destroy your credit. In the formulas used by different credit bureaus to calculate people’s credit scores, unpaid medical bills usually count less than any other type of unpaid bill. (Older methods of calculation didn’t treat medical debt differently, but newer ones do.)

            So it might make your credit score drop 30 or 40 points in the month when it’s first reported. The older the unpaid debt gets, the less it impacts your score (lose 40, get 10 back, get another 10 back, etc.). In other words, if an unpaid hospital bill hits your credit in February but you keep paying all your other bills regularly, by April or May your credit score should be on the upswing again because you’ll have 2-3 more months of regular payments/no lates on everything else.

          • rational thinker

            You are right about the medical bills. One thing that seems a little fishy to me is Obama care, everyone now has to have health insurance by law so they should have insurance. Also in many states if you are pregnant you can get medicaide/family care so there is no excuse to not having insurance. I think the family is lying about a lot of things anyway so it would not surprise me if they do have insurance. Also the coffee shop thing makes me suspicious about the go fund me.

          • Heidi

            You don’t have to have insurance, do you? I thought it was a ding on your taxes if you didn’t get insurance. I don’t know what Florida is like now, but I live in TN. We have tenncare available for any pregnant woman if she doesn’t have insurance. My mom used to work on a labor and delivery floor, and it was common for women to move from FL to TN so they’d be insured.

          • rational thinker

            I am not sure how it works in florida with the medicare state insurance but they should have Obama care if they don’t already have the state insurance. They do penalize the federal taxes if you did not get the insurance. So basically there is no reason they should not have insurance either state or federal, but they had money to pay a midwife to near kill the baby so I am suspicious about what the donated go fund me money will get spent on.

          • RudyTooty

            There are plenty of expenses outside of medical bills for a disabled person. This child could have millions of dollars in expenses over his lifetime – outside of medical bills.

            Do you know any disabled people? Are you familiar with the expenses they incur just by living in the world? Wheelchairs, wheelchair ramps, modified homes, modified bathrooms, modified cars, modified furniture….. that’s just a start.

            Medical insurance does not cover these things.

          • rational thinker

            Yes I do know a disabled person an extremely disabled person in fact I am always with this person (except when she goes to school) because she cannot be left alone for even 30 seconds. My daughter she is 14 years and still in diapers and can only talk a little and yes I have had to modify parts of my home too. If that baby ends up disabled he can get SSI disability payments right away and as for medical supplies health insurance will mostly pay for that even if he needs to be in diapers all his life the insurance will cover those if the parents cant afford them. People are surprised about the many programs out there to help these families you just have to know where to look. In this familys case I think they should try to sue the state for licensing this midwife and also the birth center and hell maybe even the EMS too.

      • RudyTooty

        OK, but how about the state of Florida?

        Florida licenses CPMs.
        Florida licenses freestanding birth centers.
        Florida authorizes Medicaid reimbursement for LM services.

        Is the state of Florida okay with these preventable injuries and deaths? Apparently so. Because they rubber-stamp this type of midwifery. The state freaking PAYS for this “care.”

        Lay blame on the parents all you want – this will continue, and continue to continue – until the laws are changed.

        • Amazed

          I said “it doesn’t absolve the lack of control”. I do lay blame on the state. But I won’t absolve the parents for knowing and rushing there to have their beautiful experience anyway. Isn’t the motiff for absolving parents “no one said anything, it was a deep secret, it was all rumours and this poor couple had no way of knowing”? Well, this couple DID know.

          • RudyTooty

            I mean, the state might revoke this one midwife’s license (oh, I doubt it!), but what is stopping more midwives like her from practicing in Florida?

            Just as incompetent.

            Just as dangerous.

            Don’t you think it creates some confusion for the public when the state authorizes and licenses and reimburses incompetent providers?

            The license alone confers legitimacy. Or the sense of legitimacy.

            Gee whiz. Look at all these “approved” midwifery schools in Florida. Sure looks legitimate to me!

            http://www.floridahealth.gov/licensing-and-regulation/midwifery/resources/approved-schools.html

            It will never change – the needless injuries and deaths will never stop – until states stop authorizing CPM practice. And the unfortunate thing is that the families will have very little recourse for the state-sanctioned injuries they suffered.

        • KeeperOfTheBooks

          I can give you one better.
          I have Cigna insurance.
          They just sent me a notification that they will now cover out of hospital births, including homebirths, with licensed midwives and CPMs.
          Morons.

  • rational thinker

    Anybody in the mood for a good laugh? I just found this article it was written a year ago but it is on a website called Pathways to family wellness and the article is called The Deadly Influence of Formula in America. The article claims that formula fed babies are at twice the risk of dying in infancy than “naturally fed babies” and the baby only gets immunities from placenta if it is a vaginal birth and some other hilarious bullshit. I don’t know how to link it from here but just google the title you will find it.

    • Anna

      No thanks, I can get enough c-sec and formula shaming from the community health clinic or the ACM Facebook page. I might as well resign myself to my two youngest being stupid and obese. Sarc.

  • alongpursuit

    Thank you for writing this! It is helping me heal from the trauma I experienced from insufficient breastmilk + relentless pressure to breastfeed + humiliation by IBCLCs.

  • space_upstairs

    The SNS is the weirdest concept to me in the world of breastfeeding. But I guess that’s because I knew I wanted to use bottles – and therefore either pump or formula-feed – in the event of having a kid for role-sharing, flexibility, modesty in certain public settings, and comfort long before I had a kid or knew there were some highly plausible holes in the paradigm of the vast nutritional superiority of breastmilk. I therefore was always skeptical of the popular notion of contact with the maternal breast itself, as opposed to comfort and attention from any loving caregiver, as being key to babies’ psychological development. I guess if people really personally feel there’s something unique and special about that contact worth such a contrived way of getting it, so be it, to each their own. But if they think they won’t love their kid and their kid won’t love them if said kid drinks from a bottle offered by a loving parent, grandparent, aunt, uncle, etc., they should get to know more bottle-feeding (with pumped milk or formula) and combo-feeding families to help them relax a bit.

    • AnnaPDE

      The rational point of the SNS is to help babies practice drinking at the breast when for some reason they can’t quite get enough milk out yet, but there’s a realistic chance that they will manage soon and mum hopes to get breastfeeding working. It’s waaaaay to contrived, work-intensive and generally a chore all around for anything but a very short term bridging solution. Been there, done that, had enough.

      • space_upstairs

        Ok, I guess, but why not let the baby suckle on the dry boob a while and then offer a bottle for a top-off? I guess there are concerns that the baby may not take a breast if it is too empty or after being introduced to bottles, but my daughter had no problem suckling before my milk came in, and will usually take a breast if hungry enough even if only offered one a couple times a day. (To be fair, though, she does seem to prefer the bottle at this point.)

        • AnnaPDE

          With my son, dry boob wasn’t great as he’d chew the nipple extra hard, and he didn’t need the extra frustration of milk not coming out. Plus, the time factor of spending time fake-feeding, then a full bottle feed, and then also pumping (because breast needs emptying!) instead of in one go was not great.
          We had a tongue tie problem (the rare “real” kind that even interfered with bottles) which ended up causing a supply issue. After his tie revision, kiddo could really use the bf-like mouth exercise to increase tongue strength and mobility; on the other hand, weeks of non-transfer had managed to almost kill my supply (which had started off fine on day 3).
          So we did the SNS for about a couple of weeks, and not at every feed. By that point he could empty what milk I had, and supply was increasing, so we could switch to the lot less tedious “effective breast + quick bottle top up” routine.

          • space_upstairs

            Ok. So I guess it has its uses to help kids who practically can’t eat at all at first to learn to suckle from a breast once they can. And, of course, for those who personally value the contact a lot. For other cases, though, it seems extreme.

          • AnnaPDE

            Completely agree. And in hindsight, I wouldn’t say it was really worth it to get the BF working instead of reviewing priorities and switching to formula. I mean, I did enjoy BF once it worked, and it had a few positives (it was a big deal for unorganised me that I couldn’t forget to bring along the boobs), but formula would’ve been just fine, too. At that time though, I was brainwashed and sleep deprived enough to want it enough to put up with the SNS for a bit.

          • space_upstairs

            Sleep deprivation made you want to put extra effort into breastfeeding? I must say my experience has been the opposite, given how sleepy I can get waiting for my daughter to finish eating from any delivery mechanism. But I guess it also makes it harder to challenge old ideas/peer pressure. I suppose that’s what you meant. Maybe that’s why I’m now thinking of pumping for a year if I can pull it off: most people around me still believe in the “vast nutritional superiority of breastmilk” paradigm, and as a non-health scientist I’ll leave it to the MDs and health researchers to go beyond modifying it to “slight nutritional superiority.” Also, I read that proper preparation of formula can be quite a sensitive matter (sterile water, exact measures, proper order of mixing), whereas once I extract my milk it’s ready to eat or heat-and-eat unless left out too long.

          • Cristina

            You get used to it. Just like you have to learn how to breastfeed, you learn how to bottle feed. It’s done multiple times a day and bottles can be a bitch but as they get older, you wash less (or you put them in your dishwasher). You can choose different forms of formula to suit your preference/budget. I liked the ready to feed ones for newborns, then liquid concentrate, then powder, but some people opt for powder from the start. You do need to get the water to powder/concentrate ratio right but it tells you right on there that for X ounces of water, add Y scoops. I would store several ready to feed bottles in my diaper bag, along with clean nipples, so I was prepared. Or just powder and clean water in separate containers, mix as needed. I think a lot of info out there is geared to make bottle feeding seem complicated but it’s really not.

          • Merrie

            Yeah, once we got the hang of it it really wasn’t complicated. We had to learn a few lessons like take powder and ask for hot water, vs take cold formula and ask someone to heat it up for us, when we went places… we had some issues at the zoo.

            I found it easier to breastfeed all things being equal, but when my husband was out with them without me, he still had to deal with bottles. And it wasn’t easier to breastfeed when I had to go back to work and deal with pumping at work.

          • AnnaPDE

            The sleep deprivation was excellent in preventing me from thinking rationally about the whole topic of baby feeding, so between my general perfectionism and the breast-is-beast belief, I didn’t get around to realising that there’s no need to put in all that effort to get to EBF until a few months after I got there. Oh well, a bit of wasted effort; if I could go back and tell my new mum self to chill out about the bottles, I would.
            At least the experience comes in handy while supporting others with similar feeding struggles.

          • Caravelle

            I’ve been combo-feeding, and I was amazed at how much simpler making a bottle of formula was than I was expecting. The box I bought came with a spoon and an edge to scrape it off of; the bottle is graduated; you fill the bottle to X amount (with bottled water, but depending on the source I read tap water might be fine too), put in the appropriate number of spoonfuls of formula for the amount of water (as written on the box), close the bottle, shake hard, serve. Apparently room temperature is fine, with that brand at least.

            The biggest constraint I’ve found is sterilizing the bottle, but the brand I bought also have a simple way of doing this in the microwave oven. And I got pumping equipment that also apparently requires being sterilized before each use, which is a much bigger constraint IMO and a big reason I haven’t pumped so far.

          • KeeperOfTheBooks

            The time thing really does seem to differ from mom-baby dyad to another. For me, breastfeeding meant an hour plus of nursing each session, and, of course, baby wasn’t getting much anyhow. For my SIL, who has zero problems breastfeeding, a nighttime nursing session was 15 minutes or so tops. To make up a bottle and feed it to a newish baby would take me around 20-30, depending on the kid. So I can believe that nursing can potentially be faster and more convenient for some moms, while also saying it certainly wasn’t for me!