Should hospital lactation support be prescription-only, restricted to those who have specific medical need?

Money Bag with money on background.

It is deeply unfortunate that many lactation professionals care more about the process of breastfeeding than the health of babies and mothers.

That’s why they come up with punitive schemes like infant formula by prescription and justify it with the belief that it is necessary to force poor women to pay for their “irresponsibility” in being poor.

The best way to highlight the viciousness of many lactivists is to flip their script.

Consider this bit of foulness from FABIE, the no-holds barred critic of the Fed Is Best Foundation, widely believed to be started by Australian Lisa Bridger.

Discussion question:

Is it OK to choose not to breastfeed but rely on formula through government welfare programs, or should free formula be available only for those who medically need it?

In my experience, the best way to highlight the viciousness of many lactivists and lactation professionals is to flip the script. When you turn their proposals back on them, it is easy to see the cruelty that motivated them.

So here’s my “discussion question”:

Should in-hospital lactation support be available only to those who have a specific medical need, documented by individual prescription?

Given that breastfeeding is natural, all other women who want hospital based lactation support would pay the going rate ($50-$100) out of pocket at the time of service. Only those women with premature babies — for whom breastmilk can improve mortality rates — would be able to access free in-hospital lactation support and only by individual prescription.

How loud and how long do you think lactivists and lactation professionals would howl about that proposal?

That makes it clear such questions are really about pressuring women to behave in ways that benefit lactivists and lactation professionals.

FABIE’s discussion question is meant to shame women who formula feed.

How dare a woman — especially a poor woman — imagine that she is entitled to determine how her own breasts are used? She should be required to justify herself to her doctor or midwife and receive the appropriate scolding for failing to adhere to her gender mandated role. And if she is poor, we can ratchet up the pressure by threatening to starve her baby unless she accedes to her own humiliation.

Don’t bother insisting that breastfeeding is what’s good for babies. There’s simply no evidence that breastfeeding has any impact on the mortality rates of term infants in industrialized countries. Lactation professionals can’t point to any real world evidence that a change in breastfeeding rates has led to change in the health of any but the most premature babies.

Who benefits by refusing to provide formula to babies on public assistance? It is certainly not those babies since pressuring women to breastfeed won’t change the fact that many women can’t physically nourish an infant fully, and many women must return to work and therefore can’t continue breastfeeding even if they start.

First, lactation consultants benefit by increased employment and income. If every women is shamed into attempting breastfeeding, and shamed if she attempts to stop, and shamed if she combo-feeds with formula, and shamed when she is seen bottle feeding, there will be greater need for lactation consultants. They would not benefit from a comparable scheme to restrict lactation support to those who have individual prescriptions for it and would oppose it with every fiber of their being.

Second, lactivists like FABIE benefit in the same way that those humiliating others always benefit, by enhanced self-esteem through feeling superior to the shamed.

Finally, FABIE and other lactivists benefit by reveling in ugly shaming behavior that is usually forbidden in polite society.

There is simply no limit to the cruelty of lactivists toward women who don’t or don’t want to breastfeed, and no limit to the delight that lactivists experience in sanctioned cruelty to other mothers.

FABIE proves it!

  • Mel

    I do agree with “Fed Isn’t Best; It’s Expected” on one point.

    Feeding your children adequately is expected of parents.

    Daily math problem:
    I was producing a bit under 6 oz of breastmilk at 16 weeks postpartum when Spawn was 2 weeks adjusted age and drinking 2oz per feeding 8x a day. As a white male preemie born at 780g, he was already at risk for failing to meet adequate growth so his formula/breastmilk needed to be fortified to 24 cals/oz instead of 20 cals per ounce. Alimentum makes 20 cal/oz formula when mixed at 1 scoop per 2 oz of water.

    a) How much liquid intake does Spawn need a day? (1pt)

    b) How much breastmilk does Spawn have available a day? (1pt)

    c)How much powdered formula should be added to the breast milk? Hint: Water is 0 cal per oz; breast milk is 20 calories per oz. (3pts)

    d) How much formula is needed? (1pt)

    e) How much water is needed for the formula? (1pt)

    f) How much powdered formula should be added to the water? (3pts)

    My husband and I are both mathy – thankfully – so this was a rather boring but manageable math problem for the six weeks that Spawn was on a combination feed regime until I dried up and we used up my stash.

    The question that worries me isn’t “How many parents in the same situation switch to formula?” because the math for that one is a simple one-off that you can use over and over and over.

    No – I worry about how many parents got the math wrong……

    ETA: You can take the teacher out of a classroom – but you’ll have to pry my point totals from my cold-dead hands 😛

    • AnnaPDE

      So do you think it would be helpful just to make a nice, simple, formula driven spreadsheet for parents to use in this situation? Or a simple calculator web page that shows the steps, so parents can be non-mathsy but still don’t have to trust a black box?
      I’d be happy to make something like this.

      • Mel

        Any of those things would be helpful 🙂

        • AnnaPDE

          On it! 🙂 Practical detail questions:
          * Would you try to account for the volume increase by adding the formula powder to the water? Say if I were to mix 4 oz of water with 2 scoops of formula, it would be a bit more than 4 oz of milky liquid afterwards, but the increase is pretty small, and measuring with scoops and bottles isn’t all that precise in the first place.
          * How do you go about fortifying breast milk: Add part-scoops of powder to a feed’s worth of milk, or figure out how much milk you need for a whole scoop, mix that up, and then divide into feed sized portions as needed? The part-scoop method seems hard to measure right in practice, but in the second one the batch size needed for a scoop seems a bit big, so I’m not sure whether that is practicable.

          • AnnaPDE

            So here’s a start, with the assumption that the formula powder’s added volume will be ignored, and the whole-scoop method for mixing powder into pumped milk:
            https://docs.google.com/spreadsheets/d/1ou-pgAfoiifxQku-lZsDW7lasA1mQaM0HbzXt2SJSp0/copy

            If anyone downloads this for use: Please check for errors first, it’s just thrown together while waiting for code to run.

          • Mel

            You don’t need to account for the volume change of adding formula to water because the amount of change after the powder dissolves is quite small.

            For simplicity, we made up a full day’s worth of milk (since refrigerated formula is safe for 24 hours ) to maximize the number of full scoops and only have one partial scoop per day. Technically, thawed breast milk is supposed to be ‘shaken gently’ until the separated fat recombines to reduce the amount of protein denaturing. Personally, my husband and I figured that the various lysozymes in the mouth, the acids in the stomach and the mechanical forces involved in sucking on a bottle were much more likely to denature proteins than using a stick blender on 6 oz of breast milk dissolved into 16oz of water so we went with breast milk + water + total amount of powdered formula + stick blender.

          • AnnaPDE

            Ah, so you mix the water, formula powder and daily pumped milk all together? Good to know! I’ll add that to the spreadsheet later this morning, link will continue to work.
            Sorry for the newbie questions, my kid was on the very simple side when it came to feeding: “MOAR!”

  • Mel

    Please don’t take any sort of medical advice or linguistic advice from anyone who comes up with “Fed Ain’t Best It’s Expected” with no sense of irony.

  • “Should in-hospital lactation support be available only to those who have a specific medical need, documented by individual prescription?”

    In my hospital, LCs are only available to see mothers who are first-time moms or who have some issue (inverted nipple, baby has tongue-tie) that would prevent breastfeeding. If you have an in-hospital appointment, which insurance covers, your follow-up is free; otherwise, you get two appointments for $75 total. So they actually do restrict lactation consultant services.

    That said, all of the postpartum nurses are really good at helping moms latch the baby. They also give us a massage before we leave.

    As of my third baby, formula is given freely upon request, and “Fed is Best” has replaced the hospital’s seeking of Baby-Friendly status. Our well nursery remains open.