Why do lactivists value ideological purity above the wellbeing of babies?


My latest piece on Time.com, The Breastfeeding Police Are Wrong About Formula, addresses new research that shows that early supplementation with formula actually improves rates of extended breastfeeding. Contrary to the dire predictions of lactivists, giving hungry babies formula until their mothers’ milk comes in does not sabotage breastfeeding.

It’s not surprising when you consider anthropological research that shows that early supplementation is common in a wide variety of cultures from the Indian subcontinent, to Southeast Asia to Africa. Mothers around the world, who fully intend to breastfeed for years, and do breastfeed for years, see nothing wrong with giving a baby supplements in the first few days after birth. So why have lactivists insisted that supplements sabotage breastfeeding and advocate letting babies scream for hours in hunger until a woman’s milk comes in?

It’s very simple; they value ideological purity over the wellbeing of babies.

Consider the Baby-Friendly Hospital Initiative, bizarrely named since it is not friendly to babies or to mothers. It is being implemented in hospitals around the country despite the fact that there is no evidence that it works and quite a bit of evidence that it does not. Indeed a paper published in the April 2013 issue of the journal Pediatrics found the opposite. According to the authors of Baby-Friendly Hospital Accreditation, In-Hospital Care Practices, and Breastfeeding:

…After adjustment for significant maternal, infant, clinical, and hospital variables, women who birthed in BFHI-accredited hospitals had significantly lower odds of breastfeeding at 1 month (adjusted odds ratio 0.72, 95% confidence interval 0.58–0.90) than those who birthed in non–BFHI-accredited hospitals. BFHI accreditation did not affect the odds of breastfeeding at 4 months or exclusive breastfeeding at 1 or 4 months…

When you consider the 10 steps of the Baby-Friendly Hospital Initiative, it’s hardly surprising that they don’t increase breastfeeding rates. Instead of addressing the problems that mothers identify — pain, difficulty, low milk supply, inconvenience — the 10 steps identify the problem that lactivists insist, without evidence, is responsible for low breastfeeding rates — cultural pressure.

Having misidentified the problem as a lack of ideological commitment, lactivists have misidentified the solution as greater enforcement of ideological purity.

Why is there such a massive disconnect between what works to improve breastfeeding rates and what lactivists recommend? Because lactivists aren’t really interested in the wellbeing of babies. They’re invested in boosting their own self-esteem by having their personal choices mirrored back to them … and punishing those who refuse to copy them by making them feel like bad mothers.

CDC statistics show that rates of combo-feeding (breastfeeding plus supplementation) exceeds rates of exclusive breastfeeding by 30 percentage points, demonstrating that large numbers of women are already successfully combining breastfeeding and supplementation. Anthropological studies show that women from many different cultures do the same. It’s time to re-orient our breastfeeding recommendations toward what actually works for babies and mothers, and away from the ideological purity demanded by lactivists.

It’s time for breastfeeding without guilt.

180 Responses to “Why do lactivists value ideological purity above the wellbeing of babies?”

  1. steph
    May 15, 2013 at 5:59 pm #

    Dr. Amy, would it be possible for you to get hold of a maternity nurse/midwife working in a baby friendly accredited hospital and find out how they achieve their status?

    When i gave birth last December in the same hospital i noticed a difference in the nurses behaviour towards breastfeeding. They now had to ask every single time whether i am breastfeeding/how it is going etc and wrote it down on my hospital notes with their signatures (?). They sounded to me like they were being harassed, tired and resigned that this is what they had to do. It reminded me of when you go to McDonalds and they ask you whether you want fries with that. Just as annoying! After another nurse asked me in this “defeated” way i asked her outright whether this affects her performance review because I had an elective C-section and i had my own formula bottle and equipment in plain view , making it obvious i am not interested in breastfeeding.)

    She told me that hospitals get more funding if the hospital has a baby friendly status and that they need to track their breastfeeding record, which they do by setting a established breastfeeding rate of mothers leaving the hospital and committing every year to raising it. They monitor which nurses gave out formula ( they have to sign out the formula and the reason they gave it, which during my stay 2/4 were due to baby loosing more than 10% body weight), how many pep talks they gave etc. Even the nurses have to ask the nurse in charge of the floor to give them the keys to get to the hot water/formula which is locked at night, as it they can not open it ( ?). They get daily team meetings in which the breastfeeding rate is mentioned and how to best achieve that result. In their performance reviews the maternity nurses get talked to about their stance on breastfeeding and how well their charges were able to do so. I found this incredibly sad for this nurse and midwife who has 30+ years experience and does not care whether they let her go because as a nurse she will always find another job. She hated the way it has gotten out of control in hospitals and told me most nurses feel the pressure, too.

    Can you please look into this and find out whether it really does affect their performance review because i find it unethical?

    • Amy Tuteur, MD
      May 15, 2013 at 6:26 pm #

      Here are the guidelines they must follow:


      • theNormalDistribution
        May 15, 2013 at 6:34 pm #

        Is there research that actually shows that breastfeeding decreases mothers’ risk for type 2 diabetes and ovarian cancer, or are those just more variables in the mess of associational studies?

        • attitude devant
          May 15, 2013 at 7:14 pm #

          The ovarian cancer thing is almost certainly from ovulation-suppression. You see the same thing in BC pill users and anorectics—fewer ovulatory incidents>>>lower risk. So that’s rather simple, and hardly unique to breastfeeding. The diabetes thing I can’t figure too easily. Type 2 diabetes is such a big group and it has so many risk factors (ethnic group, diet, weight, heredity) that an obvious explanation doe not occur to me.

          • CanDoc
            May 15, 2013 at 8:44 pm #

            Multiple reasons I can guess for lower DM2 with breastfeeding, but I would mainly hypothesize that obese women and certain minority women have very low breastfeeding rates and are at much higher risk of DM2.

          • theNormalDistribution
            May 15, 2013 at 9:33 pm #

            Interesting. Thanks everyone for the responses.

          • Sue
            May 16, 2013 at 4:31 am #

            To me, the ovarian cancer thing is just as dodgy an argument as the anti-abortion argument that says abortion is a breast cancer risk because the breast starts to develop and then stops.

            My argument to those people is that spontaneous miscarriage is very common – a much more common reason for breast development to stop than abortion. Similarly, the number of ovulatory cycles in a woman’s lifetime depends on when she starts and stops ovulating – which is highly variable – as well as how many children she has. You can have one child and breast feed for two years or have ten children and never breast feed – who has more ovulations?

        • fiftyfifty1
          May 15, 2013 at 7:53 pm #

          I agree with attitude devant regarding the ovulation suppression/decreased ovarian cancer link. I think the lower DM2 piece can be explained by a combo of PCOS and demographic confounders. The underlying problem in PCOS (polycystic ovarian syndrome) is insulin resitance. Women with PCOS are more likely to have problems with milk supply. They are also much much more likely to develop diabetes over the years. In terms of the demographic confounders, we know that breastfeeding rates are higher in white women and lower in minorities overall, and higher in the rich and lower in the poor. “Upperclass” and “white” are correlated with much lower DM2 rates.

          • Dr Kitty
            May 16, 2013 at 8:33 am #

            Although being from a higher socioeconomic group and being white are factors associated with higher rates of breast cancer.

            POSSIBLY because while rich white women may be more likely to breast feed, they are also more likely to take the contraceptive pill, have smaller families, delay their child bearing until after the age of 25, drink alcohol regularly and attend for screening mammography (which overdiagnoses breast cancer) than women from other demographics.

            As well as that, deleterious BRCA gene mutations are more common in people of Ashkenazi descent.

      • Eddie
        May 15, 2013 at 6:53 pm #

        IMHO, that document is a great resource for understanding why NOT to deliver in such a hospital.

        I don’t know if it’s possible, but you almost need a blog page of resources, links such as this that you and commenters can then refer to as source documents. Of course, people can always find the individual blog post and/or comment and link to that, but a single page with these kinds of links would be useful, I think.

      • steph
        May 15, 2013 at 7:22 pm #

        Thanks Dr. Amy, i read the guidelines and as usual when you read this document you have no idea how these guidelines are enforced and what it means in reality for both the hospital staff and for mothers. I am surprised not enough nurses have come forward and complained to the media what impact these policies have.

    • rh1985
      May 15, 2013 at 6:27 pm #

      Wow, that is just beyond absurd. I feel bad for those nurses.

    • CanDoc
      May 15, 2013 at 8:48 pm #

      Our hospital has BFI status and it’s great for women who want support for breastfeeding. For those who don’t, the lactation consultants stay away and there’s a bit of a nudge-nudge wink wink about formula use – it might not be overtly recommended by the nurses to women struggling if babies haven’t lost their 10% yet, but it may be gently mentioned as an option. The subterfuge is galling, but overall the whole experience has not been nearly as excruciating as I feared.
      The CME that nurses need to do, however, is disgusting – the online breastfeeding course that contains conjecture and misinformation is informing our new nurses, and this is a concern for me – I just keep hoping the senior nurses will continue to hold sway and common sense will reign.

      • rh1985
        May 15, 2013 at 9:55 pm #

        What do they do when a woman says she is not going to be breastfeeding at all? is she harassed about it? do they try to hide the formula?

  2. Antigonos CNM
    May 15, 2013 at 3:37 pm #

    I’d like to address another problem with the concept that the only thing which should enter a baby’s mouth is its mother’s nipple: the refusal to use pacifiers, the assumption that if a baby cries, it should get the breast virtually continually.

    Pacifiers don’t have any calories. Breasts continually leak milk, if only drops, when suckled. The baby’s mouth is continually awash with milk, which cannot be good for the teeth, once he begins to cut them, and, while most babies do not intentionally overeat, they can be trained to do so, and no better way than getting not only their sucking needs satisfied but getting a snack as well. I’ve seen lots of very fat babies whose mothers breast feed exclusively, and upon questioning, say they prefer to let the baby nurse “as long and as often as he wants” rather than use a pacifier, which is presumed to be something entirely dreadful. Babies ought to double their birth weights by 6 months, and triple it by a year, but I’ve seen babies more than triple their birth weight before 6 months due to unending sessions at the breast. And we know now that one’s fat cells are laid down in the first year of life; all they do later is get bigger and bigger, so the first year is critical in preventing later obesity.

    • Poogles
      May 15, 2013 at 7:21 pm #

      Not to mention creating the association of comfort = food when the breast is used as a pacifier/soother whenever the child is upset.

    • Suzi Screendoor
      May 15, 2013 at 9:53 pm #

      Thank you! This is one of the most useful things I have read in regards to parenting in the first year of life.

    • Charlotte
      May 20, 2013 at 7:41 pm #

      THE fattest baby I have ever met (22 pounds at 6 months) was an exclusively breastfed baby who spent literally hours every day in a carrier strapped to mom. She was fed constantly and rarely put down long enough to burn off the chub.

    • Meerkat
      May 29, 2013 at 8:58 pm #

      It’s not that simple. I have exclusively breastfed my baby, and he tripled his birth weight by 7 months. He is a very big and tall baby, but there is no denying that he was very chubby. He refused to take a pacifier or a bottle nipple. It had to be me or nothing. I had a monster oversupply, and BF on demand. Our pediatrician suggested feeding him fewer times per day, which failed dramatically- his feeding sessions were frequent but short, and he screamed in hunger when I tried to schedule feedings. I am not “one of those” mothers, I don’t co-sleep or baby wear, I don’t let him gnaw on my breasts indefinitely. Our feeding schedule and my supply have normalized now, but neither lactation consultants nor pediatricians and gynecologists could give me any coherent advice about normalizing my oversupply. I have asked for help many times, because I was very uncomfortable. They simply didn’t know how to help. What was I supposed to do? Put my infant on a diet? Feed him formula, when I had an abundance of healthy, always fresh and free food? I tried many many things before deciding to let nature take its course. I am still shocked about how little our doctors seem to know about breastfeeding problems.

  3. Julia B
    May 15, 2013 at 8:37 am #

    The other side of this is when women want to breastfeed, there are no issues with latching or supply, they gain weight, and yet their babies are fed formula. I gave birth in a non-BFHI hospital, so all the materials that were used in the hospital were plastered with the brand names from infant formula. We have photos of my daughter in the plastic crib with her name smaller than the word “Similac” on the crib label. I was encouraged to breastfeed and my milk came in about 12 hours after birth. Around 36 hours after delivery I was very tired and wanted to get in a nap, but couldn’t calm my daughter after her feed so I brought her to the nurses’ post for a couple of hours, with the instruction that they bring her to me if she seemed like she needed a feed again. When I came to pick her up, she had a bottle of formula in her bed that they seemed to be planning to give her. She had gained weight by that point and I have no idea why they would want to do that. I am sure that it wouldn’t have hurt her, but she was feeding so well off the breast. Given my hormonal state at the time, I think it would have upset me. Locking up formula in hospitals isn’t the way to go, but nor is feeding healthy newborns formula against parents’ wishes when breastfeeding is successful.

    • Kerlyssa
      May 15, 2013 at 12:58 pm #

      Maybe they just wanted to let you sleep?

    • Eddie
      May 15, 2013 at 7:23 pm #

      Unless the life or immediate health of the baby is at risk, the hospital should absolutely respect the mother’s choices, whether it’s to BF or formula feed.

      You almost describe the hospital I was born in — quite a while ago. I’m pretty sure I was 100% formula fed. I was kept in the L&D nursery all of the time except when my parents wanted to hold me, and fed formula by a nurse. (Actually, I assume a nurse. I don’t really know who fed the babies back then.)

      Why is it so hard to get the happy middle ground of just doing the reasonable stuff, and respecting the mother’s wishes? The more I hear, the more I realize the hospital where my wife gave birth is terrific. Why is it that when a hospital wants to empower the mothers and be more mother friendly, that they tend to go crazy? Now that I think about it, I notice that it’s the “Baby Friendly” hospital initiative, not the “Mother Friendly” one. I think that’s telling.

  4. Amazed
    May 15, 2013 at 4:19 am #

    I’ve heard that the best remedy for a PPH is… the baby. Breastfeeding the baby, and your uterus will contract. Stupid doctors didn’t tell my mother that and gave her this old-fashioned massage and tried to get at least some pulse back into her.

    Thing is, almost no milk there. And no one tried to address the matter. Baby was fed formula. Since this wasn’t available for free purchasing for the consumers here, I distinctly remember that the first day at home he was fed powder milk. And yes, he screamed in hunger. Big, healthy baby who was hungry and screamed. He went literally blue in the few minutes my dad needed to make his meal. And my, he was a hungry one! Still, very little milk there.

    One would think that feeding him artificial crap would ruin the breastfeeding, would cause a full dry-up and so on. It didn’t. About a month later, the milk came in – enough for twins. Only, he would have literally starved during this month my mom was making her own recovery.

    No doubt nowadays both he and my mom would have been subjected to “only breast, ’cause breast is best”. And for what reason? Making my mom feel like a supermom? She’s super enough as she is.

    • LynnetteHafkenIBCLC
      May 15, 2013 at 8:21 am #

      Is it possible she had a retained placental fragment? Do you know how her lochia was afterwards? I’m just curious, because it’s remarkable how she went from no milk to enough milk for twins after one month.

      • May 15, 2013 at 9:52 am #

        Remarkable? A woman suffered a life threatening (literally) post partum hemorrhage and you think delayed lactation was remarkable?

        I think it would be predictable, JMO.

        • KarenJJ
          May 15, 2013 at 10:01 am #

          I would love to know more about anemia and breastfeeding – as an ex-anemic and ex-breastfeeder that suffered supply issues.

      • Amazed
        May 15, 2013 at 10:04 am #

        No, I don’t know. Actually, I don’t think she knows either. All she remembers is trying to cry out that something was wrong but there was no one in the room to hear her, The next thing she remembers is the tunnel with light and then someone saying, “It isn’t there, it isn’t there,” meaning her pulse.

        I don’t find it that strange. She lost much blood, her baby was huge, she was exhausted, could barely eat and when she somewhat recovered, her milk came in. Since it coincided with – you’ll never guess – her wisdom teeth finally making an appearance, she doesn’t even know whether breastfeeding hurt – she was visiting dentists, not LCs.

        • Amazed
          May 15, 2013 at 10:50 am #

          Oh and around this time I was exiled from home – I was packed off to my grandparents. Modern theories claim it’s the safest way to achieve jealousy and fear of abandonment in a child. Fortunately, no one thought to inform me. I was, obviously, an unattached child who got displaced by the annoying little budger and too stupid to know it despite being breastfed right from the start.

  5. ratiomom
    May 14, 2013 at 11:32 pm #

    In case anyone was wondering whether the breast lobby has any ethics left, this little gem is from the comments on the `Time` article:

    “Also you are forgetting that these babies were being weighed frequently (is this normal?? My babies were not weighed so often, they looked for wet diapers instead) and had losses. The moms were already being undermined by the hysterics that usually surrounds normal weight losses. I’d like to see a study where they lie to women and tell them the baby has gained weight when they’ve had a normal loss. Let’s see what happens then.”

    This person is proposing the strategy of not weighing babies so the mother doesn`t have to break her pretty little head over the weight loss. Or alternatively, if they MUST be weighed, to just lie to the mother about the weight. It scares me sh*tless that this person is most likely involved in actual patient care.

    • May 14, 2013 at 11:41 pm #

      In fact it is perfectly normal for a NICU baby to be weighed AT LEAST daily, or more often if the infant is medicated.

      Not weighing an infant is ignoring an important measure of hydration and growth. A continuous weight loss can’t be attributed only to urination and defecation. Continuous weight loss is likely also dehydration and loss of body fat and muscle.

      The HuffPo article has multiple comments insisting that a 10% weight loss is totally normal and nothing to worry about. I have to wonder if those commenters have either eating disorders or body image disorders in order to perceive a significant weight loss as normal.

      • Eddie
        May 15, 2013 at 12:22 am #

        Reminds me of how some midwives counsel pregnant women to avoid certain tests, so they won’t have to worry about deciding not to do certain interventions. It’s about taking choice away. How feminist.

        • May 15, 2013 at 10:02 am #

          The scary thing is that once away from a hospital, some women are surrounded by people who give advice that appears to be based on wishful thinking.

          Advice such as “Keep breastfeeding and your supply will increase.” “Don’t worry if the baby seems constantly hungry, or lethargic, or nurses nonstop, or barely has two wet diapers a day.”. “If you give any formula at all, even one cc, you will permanently damage your child’s health.”.

          I wish the stories I’ve heard about lactation specialists were more consistent, but I keep hearing everything from LCs missing tongue ties to LCs who keep a supply of nipple shields handy and aren’t reluctant to suggest their use.

      • Antigonos CNM
        May 15, 2013 at 5:10 am #

        10% weight loss IS regarded as normal, but a baby should have regained his/her birth weight by the 10th day of life, if not before, and indeed, weight LOSS should have stopped before that. [Sometimes there is a day or two when the baby’s weight stays the same before beginning to gain]. The US system, which discharges usually after 48 hours, without any routine followup [mother and baby have to actually go to a pediatrician; no one comes to them, to check them both out], means [1] mother leaves hospital with no possibility of knowing just how much milk she is going to produce, or how much the baby needs [I find the hospitals’ assumption that a newborn, for instance, only needs 30 cc per feed the first day, etc. to be ridiculous. Some need less, some need more, in order to be satisfied], [2] she has no experience of a good nursing experience even if the baby latches on easily, not always the case, especially if the baby is still bunged up with meconium and hasn’t any appetite, [3] and, once at home, all kinds of other factors come into play which are not recognized, such as the demands of other children, her own exhaustion, financial situation, no assistance, etc. means she’s alone without support. She may not even recognize the incipient signs of dehydration in the baby.

        One of the glories of the UK system [when I was there, and hopefully, still], was that the midwifery service was obligated by law to perform [at least] once daily checks on new mothers and babies until the 10th postpartum day. The midwife generally knows the home situation before delivery, brings not only instruction and support but weighs the baby, can get a pediatrician or GP in if necessary. Mother’s episiotomy/laceration/hemorrhoids and breasts are checked. Another requirement for “early discharge” [48 hours rather than a full 10 day stay in hospital] is that the mother will not be physically left alone — fathers can get leave from work, if there’s no Gran or other relative available — to assist.

        We expect an awful lot from women who have just undergone a major stressful experience, are sleep-deprived, possibly undernourished [mother with 2-3 or more other children and no help are not going to cook themselves the best meals while trying to do the laundry, tend to baby on a nearly hourly basis, clean the house, etc.–and tiredness and bad nourishment DO affect production of breast milk.]

        • AmyM
          May 15, 2013 at 7:39 am #

          We had visiting nurses come to us 2x/week for the first 4wk and 1x/week for the next 3, but only because the babies were (slight) preemies and were listed as breastfeeding. They were covered by our insurance. Basically, they weighed the babies, and checked about output and were satisfied that the boys were gaining a normal amount of weight in a normal amount of time. They didn’t lose 10% in hospital, I think it was more like 7% and then stabilized, but they were early and sleepy so even with formula supplementation, we had to work to get them awake enough to eat. They outgrew that after about 2w, but no one was going to let them go hungry in pursuit of “exclusive breastfeeding.”

          • Sullivan ThePoop
            May 15, 2013 at 10:16 pm #

            With my last I got a visiting nurse, but it was because we had great insurance then through my husband’s job and they provided it.

        • KarenJJ
          May 15, 2013 at 7:58 am #

          10 days?!?!

          6 LONG weeks for my eldest! I saw the maternity nurse weekly and also had a home visit. We started supplementing after three weeks. Bloody stupid breastfeeding advice. I had a nurse refuse to give formula when I sent my husband to ask for it (while I sobbed in the room with a screaming baby that didn’t settle) and while I pumped to try and boost supply and managed to just limp over the line come discharge (24 hours of exclusive breastfeeding, baby lost 9% of birth weight) it all fell apart quickly at home without a pump.

        • Wren
          May 15, 2013 at 8:29 am #

          I’m in the UK. I also had my children in Croydon, which had a very high birth rate and apparently a very large teen birth rate at the time I had my children. With my first, I was visited 3 times by a midwife between discharge on day 3 and a visit from the health visitor at about 2 weeks. My son weighed more than his birth weight by day 6. With my daughter, I had to go to the clinic to see the midwife as they were short staffed and neither my daughter nor I was considered at risk for any problems. I think we went twice, but she had also regained to above her birth weight by day 6. When my milk comes in, I guess I have a lot.
          A 10 day stay in hospital was not at all possible when I had my kids unless there was a medical reason to stay. With my first, I had a C-section and was still sent home on day 3 to a home where they knew I would be alone with the baby the first day. My husband absolutely had to work that day. To be fair, I think that issue was just the one bitchy midwife in charge that evening. With my second, I went home about 12 hours after her birth, at my request. I hate being in hospital and I had an appointment to see the midwives the next day. My milk had never totally dried up between my kids and my daughter had clearly read the breastfeeding manual while in the womb. I think that made it easier for me to get home early.

          • Sullivan ThePoop
            May 15, 2013 at 10:14 pm #

            They kept me 9 days when I had my first and I almost lost my mind. I felt perfectly fine after one day, but I had a seizure in labor and my blood pressure would not go down. They discharged my daughter after 48 hours, but she still stayed with me.

        • drsquid
          May 15, 2013 at 7:35 pm #

          my babies apparently latched just fine but they tended to fall asleep on the breast. id pump and get some milk to feed them when id nap. because i had twins they sent a nurse out twice… babies had lost weight on her visit. went back to the doctor over and over, they ended up losing about 14% of their body weight. they didnt start gaining til i started formula (and figured out the “supplement” which i gave after letting them nurse was a full days requirement). after 3 visits to LCs who shrugged and couldnt figure out why the babies couldnt transfer milk (about half an ounce in 45 min or so). i asked a few times about tongue tie and was told no. finally coughed up cash for a home visit from a recommended LC. shocker, both had tongue tie. after clipping they nurse better but now they are 10 weeks. im used to bottles, they are used to bottles, my supply is all over the place (i used to be able to pump 8 oz but with twins i could only pump twice a day.. today so far ive only gotten 8 over 3 sessions.. but one twin nurses some). i feel like i got sabotaged and i fully intended to nurse but instead i nearly starved my twins got no sleep for the first several weeks and im still struggling to make it work because this actually was and is important to me (though i think at this point they will always be supplemented, i doubt at 10 weeks already taking fenugreek etc ill ever meet demand)

    • Jessica
      May 14, 2013 at 11:43 pm #

      How patronizing to lie to women about their child’s health.

      I delivered at a hospital that is trying to get BFHI status. It was miserable. I can tell you that neither my OB nor my son’s pediatrician are all that impressed by the intense focus on breastfeeding. I posted a few days ago that one nurse actually told me, “We don’t like to do that” when I suggested supplementing with formula instead of spending another night at the hospital. (With one actual IBCLC, despite 2500+ births per year. And she doesn’t work nights.) Hey lady, he’s MY kid, not yours.

      Because he did not nurse well in the hospital we had to do a weight check at the ped’s office the Monday after his birth. And because he was down nearly 10% by then, we had to go back on Wednesday. And again on Friday. And again a week later. The pediatrician did not take the lack of weight gain lightly. We supplemented with donor breast milk for the first few days, then with formula for a handful of feedings, by which time my milk was in and plentiful. Was it frustrating and depressing? Yes. AM I grateful they were so concerned? Absolutely.

      Eleven months later, I’m still nursing (and was able to stop supplementing after about the fourth week of life). Had we been allowed to drift along until my son started losing weight or needed to be hospitalized, I probably would have given up breastfeeding altogether – I certainly would have lost my husband’s support at that point.

    • sleuther
      May 15, 2013 at 1:10 pm #

      True story: My paternal grandmother breastfed her first child (my aunt) successfully. Her 2nd child (my dad) was feeding a lot, had plenty of wet diapers, but was losing weight. She wasn’t “doing it wrong” as she had breastfed before…. but her own father had died right before my dad was born and thus her breastmilk was “like water.” The pediatrician had her feed my dad formula (1935 version no less.) He promptly began gaining weight.

      Fast-forward many years, my dad (now retired) had a great career as a tenured professor at a top US university. Guess my grandmother should have insisted on keeping him exclusively breastfed since the formula made him “stupid.” /sarcasm

  6. Sue
    May 14, 2013 at 10:57 pm #

    I was wondering whether there was anything to being “baby friendly” other than breast feeding. It seems not.

    If you have the time, it’s worth looking through the documents on the accrediting body’s website: “Baby-Friendly USA”. There is a pdf document of “guidelines and criteria.” The only guideline that doesn’t relate directly to BF relates to it indirectly:

    “Prenatal education should cover the importance of exclusive breastfeeding,
    non-pharmacologic pain relief methods for labor, the importance of early skin-to-skin contact, early initiation of breastfeeding, rooming-in on a 24-hour basis, feeding on demand or baby-led feeding, frequent feeding to help assure optimal milk production, effective positioning and attachment, exclusive breastfeeding for the first six months, and the fact that breastfeeding continues to be important after 6 months when other foods are given.”

    There are no references given for the “non-pharmacologic pain relief methods for labor” – or for any of those measures, really. IN fact, the whole doc is only supported by eleven references, four of which relate to conditions that contra-indicate BF (maternal HIV and TB etc).

    Although the guideline on the site is the 2010 edition, there are refs from the 1990’s, and nothing more recent than 2008. They cite only TWO review papers on the benefits of BF (from 2002 and 2007) – to back up a whole entire culture change. TWO PAPERS!!

    So, since this is all about BF and not much about evidence, it should be re-named “The Hospital Initiative to Push BF Ideology at (almost) all Costs”.

    • suchende
      May 14, 2013 at 11:00 pm #

      I agree that prenatal education should cover those things. Hospitals following this insanity should have to explain it all with a straight face to women well before they’re in labor.

    • Eddie
      May 15, 2013 at 12:36 am #

      As you say… At this URL http://www.babyfriendlyusa.org/find-facilities I found this:

      Every hospital that attains the Baby-Friendly designation moves us
      closer to reaching the Healthy People 2020 goal of increasing the
      proportion of live births that occur in facilities that provide
      recommended care for lactating mothers and their babies.

      So yes, it appears to be essentially about breast feeding. Why in creation do they have to mention lactating mothers? Do the mothers who cannot lactate not count? If you’ve had a double radical mastectomy, are you not welcome to deliver at those hospitals? If you encourage a woman to exclusively breastfeed who otherwise would not, do you get a free unicorn?

      I see the hospital where my wife delivered is NOT on that list. That explains why it was so completely reasonable. There was no ideology driving things. I see this list of hospitals as a list of hospitals to NOT deliver at. I want my medical facilities and their staff to be pushing science and evidence-based fact, not extremist ideology.

      • Squillo
        May 15, 2013 at 10:47 am #

        They have three references cited to support their contention that following BFHI steps increases breastfeeding success. One is the DiGirolamo et al. study from Pediatrics, one is a survey-based study that found that BFH’s had increased bf initiation, but didn’t look at longer-term success rates, and the third is actually a WHO statement with its recommendations that itself cites no supporting research. So really only one reference that supports their assertions.

        I’m sure the new study won’t make their list of references.

        ETA: Nevemind. I see Sue found and has dissected their larger list of references.

    • rh1985
      May 15, 2013 at 2:39 am #

      Thankfully, the hospital I’d deliver at if I get pregnant is not on their list. Hope that doesn’t change in the next year or so….

      • rh1985
        May 15, 2013 at 2:40 am #

        I also find it funny that a hospital my mother hates because they made a totally non-pregnancy related mistake on a test (she was over 50 by then, I can’t remember what test) is on the list. She still talks about how BAD that hospital was.

      • Antigonos CNM
        May 15, 2013 at 5:18 am #

        I’ve already told my daughter that after her next birth, if she experiences the slightest obstruction from the hospital [which now announces it is “Baby Friendly”] in compliance with her wishes regarding feeding, she is to call me and I’ll come with a carton of these disposable, pre-filled bottles of Similac and she can stash them in her bedside table. My daughter is an intelligent woman; she learned, with her first baby, what works for her, and for the baby, and she will continue to do things her way. That meant pumping, and supplement, initially, after nearly a week of total frustration for herself and my granddaughter. Later, after each feed, she’d pump and store the remaining breast milk, and either use it as supplement when necessary or when Dad took a feeding. For her, the system worked wonderfully. Whether it was “right” according to the BF Gospel or not is irrelevant, IMO.

    • Bombshellrisa
      May 15, 2013 at 4:00 pm #

      ” “non-pharmacologic pain relief methods for labor” Oh great, they are pushing “The midwife’s Epidural” aka laboring in a tub, birthing ball and counter pressure. I noticed University of Washington Hospital and Evergreen Medical Center made the baby friendly list, which should make all those homebirth/birth center transfer patients happy-they can’t accuse the hospital of taking their babies away and giving them formula now!

      • MaineJen
        May 15, 2013 at 4:48 pm #

        To me that means “no pain relief methods at all.” Not appealing, and the exact reason I wanted a NURSE and not a doula, and a DOCTOR not a midwife.

      • Amazonmom
        May 28, 2013 at 1:28 pm #

        I am a NICU RN at Evergreen. My daughter’s weight loss was hidden from me because ” all you NICU nurses do is push formula”. I then told the lactivist that hid the weight loss from me that I would now be running the show. My daughter had lost 16 percent body weight . I fed her as much formula as she wanted and she gained enough to convince my medical director she did not need further treatment. Milk came in a week later and she transitioned well to exclusive breastfeeding.

        • Bombshellrisa
          May 28, 2013 at 1:33 pm #

          That is horrifying! They HID that from you. That doesn’t strike me as “baby friendly” or respectful to a patient.

          • Amazonmom
            May 28, 2013 at 1:40 pm #

            Things changed after my experience became known to management. Thanks for your reply!

          • Bombshellrisa
            May 28, 2013 at 5:01 pm #

            Good to hear. I hope that nobody else has to experience what you did.
            I have heard amazing things about the NICU at Evergreen!
            For some reason, the midwives at Puget Sound Birth Center have issues with Evergreen. I was once a student there.

        • Eddie
          May 28, 2013 at 4:01 pm #

          Is it possible that something like this counts as medical malpractice? That is totally unacceptable.

  7. mollyb
    May 14, 2013 at 10:51 pm #

    I can easily see how lactivists are going to spin the results of this study. They’re going to say that very few women actually have production issues (whether or not this is true) and that if they could only get the “my baby is starving” mentality out of their heads and just stick with the breast, the results would be the same. In other words, it’s not short-term supplementation that promotes extended breastfeeding, it’s a mother’s eventual confidence that she is producing enough that promotes extended breastfeeding. Convince every woman right from the start that no matter how hungry her baby seems, she has enough milk and there will be no need for evil formula to ever touch the baby’s lips, even for a short period of time.

    • suchende
      May 14, 2013 at 10:58 pm #

      But isn’t the point that BFHIs don’t help?

  8. Charlotte
    May 14, 2013 at 9:40 pm #

    This is exactly what happened to me. My baby lost well over a pound within two days and was dehydrated, so the doctor told me to supplement. The nurses refused to give me any, so my husband had to sneak some in from home. We were sternly lectured by nurses twice when we got caught and told supplementing even just a few times would prevent the baby from ever breastfeeding in the future. What it really did was rehydrate my baby, and let us focus on improving her latch without the added stress of knowing she would literally starve if she didn’t learn to breastfeed we within a few hours of her dehydration diagnosis. I am not a confrontational person at all, but going through that hell was so bad I may literally cuss out a nurse next time I have a baby if they pull this crap again.

    • May 14, 2013 at 9:48 pm #

      WHAT?! Refused to give you what the ped ordered?! That’s just criminal.

    • suchende
      May 14, 2013 at 10:05 pm #

      No one lectured me, but once we decided to supplement (also after a full lb loss) the LCs wouldn’t give me the time of day. I had three different LCs called to help me out and they were all unbelievably dismissive.

    • ratiomom
      May 14, 2013 at 11:38 pm #

      A nurse refusing to administer what a doctor ordered is committing serious malpractice. They won`t be doing that again when risk management finds out.
      I suggest you write a letter to both the pediatrician and hospital administration with as many dates, names and specific details as you can remember. Write that you are expecting disciplinary measures to be taken and a full apology. Tell them your baby suffered dehydration and that you are considering pressing charges. Enjoy watching them squirm…

      • Charlotte
        May 15, 2013 at 9:27 pm #

        I plan to write a letter as soon as I get around to it. Certainly before I have another baby, because I am NOT going to let it happen again.

    • Antigonos CNM
      May 15, 2013 at 5:23 am #

      A dehydrated baby will be lethargic and won’t latch on anything, if the dehydration is severe enough. A baby hysterical with hunger won’t stop screaming long enough to latch on and get a mouthful of milk to calm him. Nursery nurses know to give a ravenous baby a few pulls on a bottle of water to let him feel there’s something going into his stomach, so he calms down enough to take the nipple. Have to remember that a human nipple is not like a bottle nipple and many babies really don’t understand at first what to do with it — the teat on a bottle reaches back in their mouths more and they feel it more [once a baby is truly sucking on his mother’s nipple, it assumes a shape rather like a bottle nipple, but initially it barely passes the baby’s lips. BTW, another reason nipple shields can be a great help — drawing out the mother’s nipple for the baby to latch onto]

    • The Bofa on the Sofa
      May 15, 2013 at 9:57 am #

      Did you tell the pediatrician about he nurses’ refusal to allow you to follow his orders?

      The one thing I will say for general advice, if this happens to anyone else – CALL THE DOCTOR. Tell the nurses to CALL THE DOCTOR. If the doctor says you need to supplement, and the nurses refuse, you tell the nurses to call your doctor right now or you are going to.

      A doctor won’t put up with that shit.

  9. Sue
    May 14, 2013 at 8:56 pm #

    WOW! I’ve just been reading the pdf doc “Baby Friendly Facts” (sic) on the website of “Baby-Friendly USA, Inc.(is) the accrediting body for the Baby-Friendly Hospital Initiative in the United States.”

    That document reads like the manifesto of a totalitarian state! Condescending language, no references……where is the evidence for those “ten steps” and why are they misleadingly calling this “baby-friendly” when they mean “try to convince every mother to breastfeed by whatever method possible, including starving the baby”. Ugh!

  10. May 14, 2013 at 8:43 pm #

    I have 28 months of breastfeeding under my belt and it’s funny because all of mine had formula in one way or another. Despite the supposed benefits of breast milk, the child who got the least, 7 months only, is the least sick of them all and the one who had the longest stretch with no formula, 9 months, has been the most sick. The one I fed for 12 months, but gave formula from about 2 months has been somewhere in between. I know, data party of one, but I find it funny.

    • Sue
      May 14, 2013 at 8:58 pm #

      It all goes back to Bofa’s line – “all other things being equal”.

      The two greatest influences on the number of infections in the first year of life are exposure to other children and smoking in the household.

    • rh1985
      May 15, 2013 at 2:42 am #

      Well, to make it a data party of two, I have two siblings, and am the youngest. Siblings weren’t breastfed at all, formula from day one. I was exclusively breastfed for 9 months and never was formula fed, I was switched to cows milk at 9 months (the horror!) because my mother was DONE, I refused formula, and the 12 month rule wasn’t so set in stone back then. Guess who was the sickest baby and the sickest adult? Right, me! I did get the best grades in school, so perhaps I got the highest IQ, but I’d rather not have a cold every 4 weeks….

      • Antigonos CNM
        May 15, 2013 at 5:30 am #

        Data of three: I exclusively breastfed # 1 [good mother me], almost every hour, until [long story why] I was in a situation where I had no choice but to give a bottle — at age 3 weeks, he downed 250 cc, belched, and slept for a whole 3 hours. [Continued BF until 3 months]. I had severe mastitis with #2 and she was entirely bottlefed — at age 1 year she and her brother were the same weight. #3 got me first then I topped her up with supplement, and she has always been the happiest of the three. So I’ve tried all the permutations. I have great nipples but never produced more than about 60 cc of milk in a 4 hour period, despite the most strenuous effort; my daughter has completely inverted nipples which makes latching on, even with nipple shields, very difficult, but gallons of milk — so she eventually fed pumped breast milk via a bottle.

        The point, I suppose, is that there isn’t any one “correct” way to solve feeding problems.

        • Lena
          May 15, 2013 at 8:15 am #

          Data of four: I’m the youngest of three. My mother had breastfed my sisters for a few months months before giving up because of low supply. She decided not to even try with me because of how miserable her experience. Guess which one of us has never had an ear infection, doesn’t suffer from seasonal or food allergies, doesn’t have asthma, and rarely gets knocked out my a cold?

  11. Whatever name I used last time
    May 14, 2013 at 8:35 pm #

    How I wish I had known all this when I was a brand new mum 12 years ago. The first days of my son’s life were ruled and ruined by trying to breastfeed. I have no memories other than those of a hungry baby, pain, conflicting information, horrible midwives, dreading every feed, feeling like a complete failure and blood in my milk.

    • May 14, 2013 at 8:48 pm #

      Some here. I had a very jaundiced baby boy who did not want to latch and a 21 year old mother who didn’t know how to nurse. I had to nurse him 20 minutes straight every two hours but he would not stay on that long. It took me an hour to get a 20 minute feeding out of him and I had to put cold wet cloths on him to wake him up. I can’t believe we made it through it. What I don’t understand is that I had a ton of frozen milk from those first days and there was not reason whatsoever that I could not have supplemented and let daddy feed him. I remember getting so tired one day that a friend had come over to see the baby and I had to stop her mid sentence to say ” I have to sleep, right this second. Excuse me” I literally thought I was going to pass out. How the heck was that good for me?

  12. I don't have a creative name
    May 14, 2013 at 6:16 pm #

    OT: reading the description of tonight’s Duggars episode: “Josh is presented with a job opportunity 1,200 miles away; Jana and
    Jill’s client goes into labor
    ; the family attends Joseph’s boot camp

    ??? I watch this show once in a while, I don’t hate them like some people do but it’s not my style, but…. are these girls calling themselves midwives now?? I remember Jill saying she wanted to be one, but I highly doubt enough time has gone by since then for her to become a CNM. Sigh.

    • May 14, 2013 at 6:26 pm #

      Getting a CNM would require college, and being away from the family’s influence. It’s not likely the Duggar elders would approve.

      • I don't have a creative name
        May 14, 2013 at 6:37 pm #

        Good point.

        Just great. Two more undertrained nincompoops risking babies’ lives because they don’t think they need medical training.

        • T.
          May 15, 2013 at 4:03 am #

          If the baby died, it was God’s will, right? *fuming*

    • Lena
      May 14, 2013 at 8:41 pm #

      Jill is studying–and it seems all self-study–to become a midwife and Jana a doula (she doesn’t seem interested, but since single women aren’t allowed to go anywhere alone in that lifestyle it’s safe to assume that’s why she’s doing it).

    • E-m
      May 14, 2013 at 11:36 pm #

      I was just going to come on here to ask a question about that episode. The homebirthed baby was born with an omphalocele. The preceptor midwife called 911, baby later had a surgery and all is a-ok according to the show. I don’t know much about this defect, but am I right in assuming this should be detected by u/s and definitely risk the pregnancy out of homebirth (if an anatomy scan is done)? Or does it develop late enough that it could be a surprise in an otherwise low-risk pregnancy? Just got my curiosity piqued.

      • May 14, 2013 at 11:56 pm #

        That is a SIGNIFICANT defect and should be easily detected by an ultrasound.

        A-okay? [rolls eye}
        That’s a significant surgery even for a small defect since they have to close the hole in the abdominal wall and monitor the infant closely to make sure there aren’t any problems.

        For a larger defect, surgery can’t be done immediately.

        A quick search for “omphalocele ultrasound” found many such images.

        • Dr Kitty
          May 15, 2013 at 8:03 am #

          Also Omphalocoele, unlike gastroschisis, is related to chromosomal defects and some syndromes- which are usually tested for with amniocentesis soon after diagnosis (to provide more information, especially if parents may opt to terminate the pregnancy) and followed up closely after birth.

          Those babies are usually delivered by elective CS at 39weeks and have NICU care prior to surgical closure of the abdominal wall defect in first day or two of life.

          Part of my paeds rotation involved caring for a little room of gastroschisis and omphalocoele babies- they usually spend MONTHS in hospital post op, are TPN fed before being gradually moved to NG feeds and some end up being fed by PEG tubes or with colostomies or ileostomies, because their bowels don’t work properly.

          The only way a competent provider would miss omphalocoele would be if the mother refused ultrasound.

          Homebirth is NOT APPROPRIATE, those are SICK babies, and you can’t feed them orally.

      • MaineJen
        May 15, 2013 at 11:45 am #

        Omphalocele? Undiagnosed? Homebirth????
        *Stoops to pick jaw up off of the floor*
        I cannot WAIT to see what kind of damage control is going to go on with this episode, in the interest of making everything all cutesy-nice the way it always is. (I hate-watch this program more than I’d like to admit, merely for the pleasure of fuming at the TV…I think I’ll have to skip this one)

    • May 15, 2013 at 4:22 am #

      I’ve been patiently waiting for Dr. Amy to blog about the Duggar’s.

  13. The Computer Ate My Nym
    May 14, 2013 at 5:11 pm #

    I had a great time breast feeding. No pain, no bleeding, supply that made me think it was a pity that wet nursing was out of fashion because I could have had a second career. Nonetheless, the day after my daughter was born, I was dehydrated and didn’t have much milk. Therefore, she became dehydrated and spiked a mild fever. After some fuss and bother and a couple of blood cultures, I gave her a bottle of formula, her fever resolved, and she slept well for a few hours. The next day I had milk enough for triplets. And could go home on schedule with the baby instead of leaving her in the NICU for monitoring of a fever and failure to thrive.

  14. Sorin
    May 14, 2013 at 4:13 pm #

    This post is very timely because I am watching my nephew whither away. At birth, he was a very healthy 8lbs 15oz. Five weeks later, he was 8lbs 6oz. (Yes, you read that right. Technically, I think this gives him a “failure to thrive” diagnosis.) How is his “doctor” addressing this? By prescribing my SIL domperidone and telling her to stick him back on the breast and to come back in a week.

    I seem to be the only one in the family freaking out about his lack of weight gain. I emailed her a non-panicky email (it was hard!) suggesting that she supplement with formula while waiting for her supply to increase. I told her she can always take the formula away, but for now, her first priority is to get some weight on him. She basically responded that she’s determined to do it this way, and she refuses to supplement. All I can do is look at my tiny nephew and shake my head. My heart breaks for him.

    She’s got all the charlatans around her: a doula, a lactation consultant, a family practice doc, and an acupuncturist. (Note, that I’m not implying that their professions make them charlatans. It’s just that these particular people clearly have no idea what they are doing.) On Sunday, I watched my brother-in-law give the little guy a bottle and could see immediately that he had something wrong with his latch. My DH noticed it too (so you *know* it must have been bad!) It took him a very very long time to drink a small bottle of pumped milk, which explains why he’s on the breast 24/7 and still tiny.

    But despite the fact that I nursed my 3 year old for a year, I clearly don’t know what I’m talking about. And they would rather pay a bunch of people who are giving them terrible advice at my poor nephew’s expense.

    • Guestll
      May 14, 2013 at 5:05 pm #

      If his weight continues to fall, or if he doesn’t gain, make a call to your local child protection agency. FTT is no joke.
      Domperidone may do the trick if her issues are related to supply and your nephew’s latch on a bottle may not be indicative of latching issues at the breast. That said, again — if the situation doesn’t show signs of getting better in the next week or so, I’d call CPS.
      Your SIL isn’t making rational decisions for her son right now; her choices are emotional and she’s not seeing the proverbial big picture. I know, I was once in her shoes. Good luck to your family.

      • Sorin
        May 14, 2013 at 10:57 pm #

        Thanks, everyone, for your advice. (I’m going to try to address everyone in one post)

        “Isn’t 24/7 sucking a bad, bad sign?”

        Yes. You and I know this, but unfortunately, the quacks she’s
        listening to are encouraging her to keep him on the breast all the time. When he was first born and was constantly nursing, I suggested to her that he was using her as a pacifier. I then gave her some tips to help him realize that nursing should be all about eating—get in there, eat, be done. Now after watching him drink so ineffectively from a bottle, I realize that he’s constantly sucking because he’s not efficient.

        “Why a family doc, not a pediatrician?”

        So here’s another reason why I roll my eyes. Her insistence on this family doctor is due to the woo she’s steeped in. She was originally going to have a home birth, and this was the only doctor who would serve as a back-up to her CPM. So, of course, my SIL loves her. Now, I have pediatricians on my
        side of the family, so I know how important the specialization is, especially when things are going wrong. I’ve even had a personal experience with slow weight gain with my DD, and my pediatrician was on top of it. DD was gaining, but she wasn’t gaining enough for him (she was maybe gaining 4oz a week instead of the recommended 5-7), and he was on me–no more than 3 hours between feeds, take off her clothes to wake her up, etc. I ended up having to go in to see him every week for the first month of DD’s life which was a pain, but I appreciated his diligence.

        “Either there is a medical issue with the baby or he is too
        tired to feed effectively. He really sounds like he needs to spend some time in an SCN with a nasogastic tube in to ensure that he’s getting enough milk. And probably a few other tests as well.”

        He does sleep a lot—certainly more than my DD did! They love it because they say he sleeps well. I told them what my doc said about making sure DD ate at least every 3 hours (we could go one 4-5 hour stretch at night) because at this age, eating is more important than sleeping.

        I also suggested that maybe he get tested to make sure his
        metabolism is ok. I doubt she’ll listen to me.

        “maybe suggest that she supplement with donor breast milk
        from a bank and pump around the clock to increase her supply? she could feed using an SNS. even a lactivist would approve and it would get some weight on the baby. everybody wins : )”

        Now that’s something she might actually do. Of course the
        cost of it is so much more than buying a can of (organic) formula.

        “What does your BIL have to say about this?”

        He hasn’t really said anything. He’s letting SIL run the
        show. He has had no experience with babies (actually, neither does she), so his tiny size doesn’t seem to bother him.

        “You might consider calling Child Protection now. This baby
        is literally starving.”

        I know he’s starving. She actually called me today after I
        posted and said that she came back from the doctor and he gained a pound in a week. I hope he’s turned a corner so that I don’t have to struggle with the decision to make a call like that one.

        “Good luck to your family.”

        Thanks! We need it.

        • Erika
          May 15, 2013 at 2:30 am #

          I’ve never posted on here before, but for some reason can’t stay away from this story. My daughter had a tongue-tie (and a weak suck) which made feeding an issue. It was a posterior tongue-tie so it is not as easy to spot. My daughter fed all the time and didn’t gain weight fast enough. So the lactation consultant at the pediatrician’s office advice was to feed her for less time. Glad to say that I didn’t take that advice. We ended up working with a speech pathologist to get her tongue working well. If this little guy can’t suck well at the bottle or breast, in addition to his current problems he may have some future issues (moving his tongue properly to eat solid food, making certain sounds that require tongue movement). He also may have issues with aspirating milk during eating which could lead down a bad path as one might imagine. I guess my point is that in addition to everyone’s great suggestions to encourage this mama to feed her child the food he so desperately needs, you may want to encourage them to look into why he isn’t sucking properly. It doesn’t mean she has to give up breastfeeding, but this may be an important angle for understanding the whole picture. I could write a much longer post on this whole topic, but I won’t subject everyone to that.

          • Wren
            May 15, 2013 at 9:19 am #

            My son also had a posterior tongue-tie, which went undiagnosed until after he quit nursing. I have a huge oversupply once my milk comes in, so that is probably the only reason he did gain well. He narrowly escaped having it clipped at 1 by a fall with his pacifier in his mouth tearing it for him. Had he been my second, I would have known there was a problem much earlier. I did suspect a problem, but dismissed it when my concerns were dismissed, despite 9 months of somewhat painful breastfeeding. At 7 he still struggles with certain speech sounds and that is, according to both speech therapists he has had, likely in part due to not being able to move his tongue properly for the first 12 months.
            It does sound like they’ve found something that helps, if he is gaining now, but I’d still want the sucking issue investigated if it were me.

          • Sorin
            May 15, 2013 at 12:58 pm #

            Thanks both of you for the suggestion about the tongue tie. You actually reminded me that she said that my nephew seems to have difficulty with tongue mobility. She said the he couldn’t stick his tongue out all the way. But she mentioned it in an “isn’t that funny way” instead of a “hmm…that may be the source of his problems” way.

            I’m going to subtly suggest to her that she take him to a real pediatrician or at least a competent LC who could actually do something about it.

          • Amazed
            May 15, 2013 at 1:22 pm #

            Good luck! I hope everything resolves soon. Poor kid needs to eat.

        • Hannah
          May 15, 2013 at 5:29 pm #

          One thing to consider before calling social services would be would they do anything (other than engendering a rift in the family) given that the baby’s under the care of various medical professionals, at least one of whom, presumably, has a medical degree, who are signing off on this course of action?

          Bringing up the possibility of tongue tie directly, could be fruitful. The good news, if that’s the underlying problem, is that my understanding is that it’s relatively easily fixed, and needn’t spell the end of breastfeeding. Your relative might be receptive to the suggestion as she can’t be having a good time, either.


    • Amy Tuteur, MD
      May 14, 2013 at 5:13 pm #

      You might consider calling Child Protection now. This baby is literally starving.

    • Jessica
      May 14, 2013 at 6:20 pm #

      The words that resonated with me when my son was not gaining weight well in the first week of his life came from a wonderful LC who said, “I like breastfeeding, but I like smart babies more. Babies need enough food for their brains to grow. If baby’s not getting enough milk at the breast, you have to supplement.”

      I would be worried sick about your nephew. I am so sorry. What does your BIL have to say about this?

    • guest
      May 14, 2013 at 7:24 pm #

      maybe suggest that she supplement with donor breast milk from a bank and pump around the clock to increase her supply? she could feed using an SNS. even a lactivist would approve and it would get some weight on the baby. everybody wins : )

    • Phascogale
      May 14, 2013 at 7:38 pm #

      The part that’s extra concerning is the fact that it takes the baby a long time to drink out of a bottle. Theoretically if mum was expressing and topping up with EBM with the same amount as if she was giving formula then it shouldn’t make a difference. Either there is a medical issue with the baby or he is too tired to feed effectively. He really sounds like he needs to spend some time in an SCN with a nasogastic tube in to ensure that he’s getting enough milk. And probably a few other tests as well.

    • May 14, 2013 at 9:02 pm #

      My Ped let my daughter stay at the same weight from 4 months until 9 months before suggesting formula. I wish he had made the call sooner.

      • LynnetteHafkenIBCLC
        May 15, 2013 at 8:31 am #

        Omg. I have no words. How is she doing now?

      • Guestll
        May 15, 2013 at 9:09 am #

        My ex-GP let my daughter do something similar. I had no mechanical issues, nor did my daughter, but I had terrible supply problems, likely caused by very low prolactin levels.

        Said it before here and I’ll say it again: it’s not just the crunchies & lactaloons who’ve swallowed the “breast is best AT ALL COSTS” ideology whole.

    • AmyP
      May 14, 2013 at 9:23 pm #

      “It took him a very very long time to drink a small bottle of pumped milk, which explains why he’s on the breast 24/7 and still tiny.”

      Poor little guy! The poor performance even with a bottle sounds like my two oldest children when they were infants. My husband pointed out to me that our first and second children were both very poor at sucking a bottle nipple, although we didn’t have the frame of reference to understand that at the time. In fact, he manually enlarged their bottle nipples with a hot needle (don’t do that at home, kids!) so they would be able to get something out of the bottle. It was very surprising for us to have our third baby and to see what a good sucker looks like in action–she sucked like crazy both at the breast and bottle from the very beginning.

      Isn’t 24/7 sucking a bad, bad sign?

      I know you’ve probably used up all your free advice cards with SIL, but maybe you could poke around the Fearless Formula Feeder’s site and send SIL a link to one of the first-person stories that sounds similar. Stories are more persuasive than stats.

      “come back in a week”

      Oh my stars and garters!

      Why a family doc, not a pediatrician?

    • Dr Kitty
      May 15, 2013 at 8:11 am #

      There is something wrong with that baby.
      Cardiac babies need a lot of calories and take a long time to feed, so tend not to thrive- if he’s at all pale or blue he needs to be in the ER- NOW.

      Babies with neurological problems can have very poorly co-ordinated suck-swallow-breathe reflexes.

      It may even be most appropriate for that child to have breast milk via a tube.

      It doesn’t sound as if supply is the problem- it sounds like the baby either can’t feed, or that any amount of feed simply isn’t enough for his needs (reason yet to be determined).

      Kid needs to see a paediatrician for proper tests.

    • LynnetteHafkenIBCLC
      May 15, 2013 at 8:30 am #

      Dear God, that is terrifying. Maybe she could get a second opinion from a lactation consultant who actually cares about the baby’s growth. Obviously it would be best if she were willing to see a pediatrician, but since she prefers to get advice from crunchy type people, maybe she would feel less threatened by an LC. If you tell me what city she is located in, I might be able to recommend someone with actual brain cells.

      • Sorin
        May 15, 2013 at 12:55 pm #

        Thanks, Lynnette! She’s in Milwaukee. She keeps mentioning working with an LC, but when I asked her if her LC has done weighted feeds, she said no. When I was having problems nursing DD, the first thing my LC did was a weighted feed. I thought that was standard procedure and one of the first things an LC does.

        Like I said–charlatans.

    • ANH
      May 15, 2013 at 8:36 am #

      sounds like a tongue tie. any lactation consultant worth her salt should recognize that the baby has a poor latch and that’s affecting low supply (in that situation domperidone won’t do anything)
      seriously, if something is wrong with that baby’s latch why on earth isn’t that being corrected?

      I hope your nephew’s situation improves

      • drsquid
        May 15, 2013 at 7:55 pm #

        my twins had a fine latch but couldnt transfer milk.. i kept asking about tongue tie to 3 different kaiser lactation consultants.. got toldk no no no.. finally saw a lc i paid out of pocket.. immediately diagnosed them with tongue tie. they got clipped at 10 weeks and immediately each were able to tansfer much more milk (previously .5 oz in 30 min, now over 2 oz in 15) but they get frustrated now. im still giving nearly as many bottles and my supply is so so. im still pissed. (heh but given that they are only 11 qweeks now.. there is still a chance)

  15. Elle
    May 14, 2013 at 2:06 pm #

    Reading through the “ten steps” in the link, I think that a lot of them sound good in theory. They are vague enough that, if implemented by kind and compassionate personnel, they could be very helpful. For example, “Practice rooming in – allow mothers and infants to remain together 24 hours a day.” Key word: allow. The problem comes in when some overzealous staff take that word to mean “require.” Unfortunately, many couples have had to fight hospital staff to get to “room in” with their baby, and so this kind of policy prevents those who really WANT to room in from having to spend time after birth advocating for it.

    Other example: “Encourage breastfeeding on demand.” On the surface, great idea. I’m appalled when my mom talks about how utterly unhelpful the nurses were when she gave birth to me – she was told nothing whatsoever about breastfeeding… they didn’t even care, just brought me to her and walked away, then complained when I was hungry a few minutes later. I’m thankful to have given birth in an environment that encouraged breastfeeding. However, the key word is “encourage.” Some people will take that to mean “strongly recommend to the point of harassment,” and that’s not cool.

    So some of it sounds like a good idea to aim for if done in moderation, but then you get ones like this: “Give infants no food or drink other than breast-milk, unless medically indicated.” Which infants? Just the ones whose moms definitely want to exclusively breastfeed? And what does the term “medically indicated” mean? Does that mean baby only gets formula if they’re starving? Is that enough medical indication? What if mom doesn’t want to breastfeed? Do they get nothing?

    I think your assessment makes some very good points. I really believe these guidelines CAN be used for good if they’re rephrased a bit – but only if they are educational and not punitive. My favorite statement for reading and following parenting books is “don’t follow a rule off a cliff,” and I think it applies here too. It’s sad that in some cases, a good idea becomes a bad one because it puts rules before the welfare of people.

    • Phascogale
      May 14, 2013 at 7:43 pm #

      “And what does the term “medically indicated” mean? Does that mean baby
      only gets formula if they’re starving? Is that enough medical
      Yes that is enough indication. Usually what you would do is get the mum expressing and top baby up with that. If she doesn’t want to express or can’t get enough milk then you need to feed the baby with something. A lot is time dependant. You wouldn’t necessarily say a baby who is 3 hours old is starving. But one that’s 4 days old, hasn’t passed urine in 36 hours and is very jaundiced and is crying (or not if he’s sleepy from not feeding and the jaundice) is.

    • Sue
      May 14, 2013 at 9:04 pm #

      Excellent summary, Elle – it’s the absolutist language that plays right into the hands of the lactivists. They don’t want to “encourage” or “allow” – they want to “require” and “mandate”.

      Some of the propaganda reads exactly like the anti-vax line: “We favor choice. If you are correctly informed, however, there is only one choice you could possibly make.”

  16. Not My Normal Nym
    May 14, 2013 at 12:46 pm #

    Reading this article and some other articles I’ve seen recently makes me really angry and sad, because I gave up breastfeeding my son after paying a very expensive lactation consultant hundreds of dollars to give me terrible advice. Two of my friends used nipple shields and were able to nurse for months–the LC never recommended them to me even though my nipples were literally covered with scabs and I bled at every feeding and suffered excruciating pain. I was warned against supplementing, even though it was clear my son was hungry after every feeding and eventually refused to nurse at all because he was so frustrated. And the LC reassured me that his latch was fine, even though at 18 months we discovered he had oral-motor issues that prevented him from eating solid food and almost certainly interfered with is ability to nurse. The fear, the shame, the exhaustion and depression that resulted tainted the first three years of my son’s life, something I deeply regret. If I’d gotten some reassurance that yes, nipple shields are okay, yes, you can supplement and if it doesn’t work out, it’s okay, it would’ve spared me a lot of emotional and physical pain.

    BTW, this LC came from a place called the Pump Station in Los Angeles, the most prominent LCs in this city, but they are charlatans. I’ve met other women who were treated poorly by them. Stay away and save your money.

    • mimi
      May 14, 2013 at 3:16 pm #

      Nipple shields worked for both my babies. I BF 18 months for one and 2 yrs for the other. My hospital didn’t stock them at all.

      • suchende
        May 14, 2013 at 3:19 pm #

        I didn’t even know nipple shields existed until after a week of agony and some desperate google searches.

    • A Nony Mouse.
      May 15, 2013 at 1:26 am #

      The crazy women at the Pump Station tortured me, too, when I was having terrible problems breastfeeding. “Babies are like little camels,” they told me, “because they have stores of fluid when they are born, so they don’t need to nurse until their mother’s milk comes in.” My husband laughed out loud at that one, and we walked out.

      But, that place is raking it in, hand over fist. Don’t kid yourself — breastfeeding is big business to the Pump Station and places like it.

  17. hph
    May 14, 2013 at 12:44 pm #

    Amen. Supplementation is what saved 3 of my 4 babies from hospitalization, AND allowed me to ultimately exclusively breastfeed for one year each. It was still a hard, challenging time, and I felt so terrible about the formula, but it WORKED. Now looking back, I don’t feel guilty at all, except that for one of the babies, I feel guilty that I didn’t give her more formula! Her photos from those early weeks are awful looking.

    It was tricky, not to mention awfully hard work to balance the formula and attempted direct nursing – I didn’t want to sabotage the nursing. Did a lot of pumping. But baby #3 did not latch on AT ALL until she was 3 weeks old, when all of a sudden she woke up and did it. All of those prior bottles did not stop her – although I was very worried that they would and that I would have to pump forever/quit. Then baby #4 did not figure out how to latch until he was several weeks old also! Had a niece that didn’t latch until 4 weeks. I finally realized that the stuff I had read in books about “nipple confusion” was false. And that if a baby doesn’t latch soon after birth, he never will. False. Sure, it may be harder, but not impossible.

    If I had known then what I figured out after 4 kids, I would have had a whole lot less stress during those early weeks.

    So glad to live in a time when formula is available! How many babies were “sickly” and died long ago because of breastfeeding problems? I’m sure that was not always a wet-nurse available, and a wet-nurse won’t help all situations, anyway.

    • AmyP
      May 14, 2013 at 9:33 pm #

      “Had a niece that didn’t latch until 4 weeks. I finally realized that the stuff I had read in books about “nipple confusion” was false.”

      One of my friends had a slightly premature baby who didn’t latch on until around 3 months, as I recall. My sister used a nipple shield for a number of months, but was able to graduate to direct feeding eventually.

      My current (third) baby had a patch in the first week or so after she was born where she was 100% bottlefed while we were dealing with jaundice (she had previously been a very precocious, capable nurser from her earliest hours). Miraculously, she was able to transition back to 100% nursing. My first two kids never latched on, so this blows my mind.

      I very much believe that “nipple confusion” may be very much oversold. It may just be that the baby is a bad sucker.

  18. May 14, 2013 at 12:43 pm #

    The loss of focus on what really matters – adequately nourished babies and physically and emotionally healthy mothers is astounding! It is almost as though they really believe that completing a set of activities (a checklist of mothering) is sufficient to good mothering – seems as though they completely confuse correlation with causation.

  19. moto_librarian
    May 14, 2013 at 12:42 pm #

    Wow. My hospital is in the process of becoming “baby friendly.” I am going to be writing a letter to labor and delivery, asking how they can justify further implementation of this policy given the complete lack of evidence.

  20. fiftyfifty1
    May 14, 2013 at 12:29 pm #

    But if I admit that it can work better to supplement in the first few days, then that is admitting that breastfeeding is not perfectly designed! It’s a slippery slope! Then I might have to consider that vaginal birth might not be perfect! (and then I might even have to consider that *I’m* not perfect).

    • yentavegan
      May 14, 2013 at 1:39 pm #

      a very wise women once told me that the history of humanity is not written in beautiful births and plentiful breastmilk. lactation is not a perfectly tuned body function. We have progressed because we have adapted our behaviors and environment to overcome the losses our ancestors suffered.

      • Eddie
        May 14, 2013 at 3:38 pm #

        Thinking about this, with dogs and cats my family had as pets when I was a kid, with roommate’s pets… I don’t remember any dog or cat ever having trouble feeding its babies. Why is it that people are different? Is this understood? Do the other big apes also have similar problems? Do farm animals have these kinds of problems at the same rate as people?

        • J. Braidz
          May 14, 2013 at 4:19 pm #

          Well, when our dog had puppies, all except one of these puppies became deaf. And someone said that it had to do with some sort of poison developing in the mother dog’s milk!? I have never heard a similar story (of deafness being caused by toxic substances in the mother dog’s milk) before or since. But I, a teenager at the time, saw that nature can be very cruel. The deaf puppies had to be put to sleep, nobody wanted the responsibility of adopting a deaf puppy.

          Also, this same mother dog of ours rolled over some of her puppies so they were smothered, just a day or two old. Nature is not as idyllic as many of us would like to believe. Makes me glad that medical science can remedy at least some situations.

          • Eddie
            May 14, 2013 at 5:12 pm #

            Jennifer2 & J.Braidz, thanks for the feedback. My brothers learned about this side of nature when they got hamsters, which in every case in our house ate or killed their young. (Apparently, pet stores are unable to tell the gender of hamsters.) It doesn’t surprise me that other animals have the same problems as people; I just had never seen it so I didn’t know.

          • Karen in SC
            May 14, 2013 at 7:09 pm #

            Obviously, you needed the services of a Certified Hamster Midwife!

          • Eddie
            May 14, 2013 at 7:11 pm #

            ROFL! How did that not occur to me!?

          • May 14, 2013 at 6:25 pm #

            Deafness can be related to lack of pigment in dogs. Any dog that has white skin is at risk for this hearing loss. This is why the Dalmatian breed has a high incidence of deafness, and why blue eyes are considered a fault. (Blue eyes lack pigmentation and are correlated with a higher incidence of hearing loss.)

            (Dogs with white FUR but with black skin are not at increased risk. See Great Pyrenees for an example.)

          • Squillo
            May 14, 2013 at 9:18 pm #

            Cats, too. White cats with blue eyes have higher rates of deafness than the general cat population (although not at the huge rates some folks claim.) They lack certain cells in the inner ear that are also related to lack of pigment. I assume it’s the same mechanism at work in dogs.

          • J. Braidz
            May 14, 2013 at 11:38 pm #

            Anj, thanks for the info. Our dog was in fact a Dalmation. And the only not-deaf one in the litter was one of the darker ones.

        • Jennifer2
          May 14, 2013 at 5:00 pm #

          I have an acquaintance who fosters cats. She posts frequently on Facebook about mama cats and kittens who have problems with nursing. Other mamas “adopt” orphaned kittens. She and her husband bottle feed kittens.

          A brief Google search suggests that lactation failure is somewhat common in cattle, and even more so (or at least better studied) in swine.

          Zoos with captive breeding programs often report mothers not knowing how to care for their young (not necessarily a lactation issue).

          Successful reproduction of a species is not perfect. It allows for a significant amount of failure, error, and death on an individual level.

        • Mom of a bunch
          May 14, 2013 at 5:22 pm #

          I used to raise alpacas. I can’t speak to rate or frequency in general; this is just my experience: Most mom/baby pairs did just fine, but others needed help. Some babies seemed clueless, some moms were kind of flighty and had trouble standing still long enough for baby to nurse, some moms had low milk supply and we had to supplement, and so forth. The main advice was *always* to do what you had to do so the baby was gaining weight. Sort of a “well, duh!” isn’t it? :)) (Not that animal people can’t get into their own kind of woo, also, because they sure do.)

        • LukesCook
          May 14, 2013 at 6:01 pm #

          We had a dog who had serious mastitis and nearly died. We had to pull a leg warmer over her body to keep the puppies from suckling, and had to feed them by teaspoon.

          • AmyM
            May 14, 2013 at 7:05 pm #

            I worked on a dairy farm for a while in college, and mastitis was a common occurence–leading to what the farmers called a “Three-titted ‘un.” We’d test each quarter by hand before hooking up the machine, and if we got “cheese” that quarter did not get milked into the system. We’d try to clear it by hand if possible, sometimes they needed treatment.

        • Jules
          May 14, 2013 at 6:09 pm #

          We raised goats back in Romania and there were plenty of times when newborn kids had trouble feeding. It was always scary realizing a kid wasn’t feeding properly because at that point, fixing the situation ASAP was crucial. Otherwise, its weight and health would begin deteriorating.

        • May 14, 2013 at 6:21 pm #

          I read a very thorough article on the eastern white tailed deer.

          25% of the fawns born to first time mother does died. It didn’t say why, although it speculated that new mothers needed practice to site a natal territory that was relatively predator free and also had enough forage to support lactation.

          Since experienced mother does had a significantly better success rate, it implies that instinct and native ability can be improved on.

        • Bystander
          May 14, 2013 at 7:12 pm #

          The short answer is: they do. When you start paying attention and/or see lots of animals, you realise that anything that *can* go wrong, *does*. The rates differ. In domestic animals, it goes from v. low — like camels where obstetric problems are in the low single digits to nearly 100% i.e. if you don’t lend a hand, you won’t have any young: most breeds of geese and turkeys are dependent on people for breeding and egg incubation. Among farm mammals, losing cattle to eclampsia is painfully common — it’s brought on by milk production. And don’t get me started on mastitis.

          • Eddie
            May 14, 2013 at 7:53 pm #

            The abundance of responses I got — thank you everyone! — confirms what I suspected: That my sample size was simply too low to be meaningful. My father was raised on a farm, but they didn’t raise animals at all. My wife was raised on a farm, but they didn’t breed animals other than chickens. They would buy a weaned youth (pig, goat, cow), raise it to adulthood, and then either sell it or butcher it. Her family’s farm was a subsistence farm, most of their crop was for the family’s consumption.

            One thing I just love about this site is the wealth of expertise across so many different disciplines. Again, thanks, everyone.

            My personal experience with birth/feeding failures in animals is restricted to hamsters killing their young and the cat we had when I was in 1st grade having kittens and being too tired (?) to open the sack of the last kitten to be delivered. I remember very little of this, just that the kitten was surrounded by a sack and the mother cat didn’t do anything to help. My mother panicked and got something — scissors I think? — to get the kitten free. The mother cat was prepared to leave the kitten to die. Once we rescued the kitten, the mother did care for it.

          • The Bofa on the Sofa
            May 16, 2013 at 9:58 am #

            One thing I just love about this site is the wealth of expertise across so many different disciplines. Again, thanks, everyone.

            Recall 1st Pablo’s Law of Internet Discussion: Regardless of the topic, assume someone participating knows more about it than you do.

          • Eddie
            May 16, 2013 at 12:14 pm #

            I like it!

          • AmyP
            May 14, 2013 at 9:37 pm #

            “And don’t get me started on mastitis.”

            Yeah! I was once telling my grandma (a farm wife) about my struggles with mastitis. My grandma knew it as “milk fever” and as an affliction of cows, rather than a people problem.

        • Laural
          May 14, 2013 at 7:19 pm #

          Hi Eddie, I can totally see why you would think that, but, I think it is a common misconception that plays into the whole ‘natural idealism’ that underlies lactivism and NCB philosophy.
          Humans are not different than other mammals in having lactation problems. I’m familiar with dogs. Tube feeding is something a serious breeder probably is familiar with. Bottle feeding is so time consuming and in some scenarios one can lose the whole litter if you can’t feed the pups. Sometimes it is just the small ones that can’t fight to get a nipple, other times it could be a serious infection in the mother, but, yes, all mammals are subject to lactation failures. Just like they are susceptible to birth failures. Sometimes you can see a pup has been dead for a while, but sometimes you can tell they just didn’t survive the birth itself. Sometimes they wake up and start breathing with resuscitative effort and that is freaking awesome. Bitches can have retained placentas, or even puppies, and need pitocin or face very serious consequences. It is not uncommon for a bitch to accidentally trample or smother a pup during the whelping. I’m sorry for the long post, and for using your question to give this diatribe; but, people who are familiar with birth in nature, or ‘natural birth’, know that ‘trusting birth’ is not what you do if really care about the mothers and babies. You are there with whatever lifesaving intervention you have access to and can provide.

          • auntbea
            May 14, 2013 at 7:37 pm #

            I realize that “bitches” is actually a technical term as used here, but mostly it makes me want to read this comment in Snoop Dogg.

          • KumquatWriter
            May 14, 2013 at 10:54 pm #

            *Snoop Lion

          • auntbea
            May 15, 2013 at 9:30 am #

            You’re right. I forgot.

          • Laural
            May 15, 2013 at 11:24 am #

            Too funny. I get into trouble with that. I should try to use ‘mother dog’ but even that kills me; a dog is male.

          • Eddie
            May 14, 2013 at 8:24 pm #

            No reason to apologize for length nor diatribe. I appreciate all of the information. My sample size was just too small to be meaningful. I just wish that the NCB crowd were open to seeing that the same is true for them.

            In grad school years, I bottle-fed kittens — mother was a feral cat we sometimes saw around who disappeared and who we never saw again. But you can’t really call “disappearance of the mother” a lactation failure. 🙂

            100 years ago, much more of the population lived in the country and were familiar with animals. People KNEW this stuff. Today, most people are insulated from this. Some people are aware they are ignorant. Others assume their experience is representative and think they know.

          • BeatlesFan
            May 15, 2013 at 1:07 pm #

            I helped MIL whelp a litter a few years back- four pups total, and one didn’t make it. He was born alive but in very rough shape- I’m not sure what happened, but his head seemed very floppy on his neck, which made me think the bitch (a first-time mother) had accidentally sat on him or something. (He was the last pup, too, so maybe she thought she was done?) I fought like hell to save that pup- rubbing him in a towel, spoon-feeding him honey, giving him mouth-to-nose; in spite of my best efforts, he only lived about an hour and a half. I was quite upset when he died- not only because I tried to hard to save him, but also because I was about 6 weeks pregnant with my son at the time, and it really hammered home the lesson that safe birth isn’t a given, life isn’t fair sometimes, and nature doesn’t really give a damn.

        • Suzi Screendoor
          May 15, 2013 at 11:39 pm #

          My family farm calves out about 200 cows every year and bottle-feeding is a regular occurrence – I’d say at least 20-30 calves per year get some supplementation. Some calves are just slower to figure things out, less experienced cows often don’t stand still to allow the calf to suck, cows get mastitis, preemies don’t nurse well, bad weather throws a kink into things, sometimes they just don’t bond right away… so the calf gets some bottle feedings until it can nurse from mom. We even have bagged colostrum for the earliest feedings.

          What’s not cool is getting breastfeeding advice from your family that is entirely based on cow anatomy and behaviour! Did you know cows actually lick their babies’ bums to stimulate the suck reflex?

          • Eddie
            May 16, 2013 at 1:31 am #

            Now that’s just too funny! A hazard of growing up on a farm, I guess. I did not know that cows had such an unexpected way of stimulating the suck reflex. Also, more than 10% getting some supplementation … I would never have guessed. Thanks!

          • fiftyfifty1
            May 16, 2013 at 8:43 am #

            ” Did you know cows actually lick their babies’ bums to stimulate the suck reflex?”
            I thought that was to get them to poop.

  21. The Bofa on the Sofa
    May 14, 2013 at 12:04 pm #

    After adjustment for significant maternal, infant, clinical, and hospital variables, women who birthed in BFHI-accredited hospitals had significantly lower odds of breastfeeding at 1 month (adjusted odds ratio 0.72, 95% confidence interval 0.58–0.90) than those who birthed in non–BFHI-accredited hospitals. BFHI accreditation did not affect the odds of breastfeeding at 4 months or exclusive breastfeeding at 1 or 4 months…


    This is killer. The generous interpretation is that there is no effect. Slam the door. That should be the end of the whole “baby friendly” nonsense. Of course, it won’t be.

    • Staceyjw
      May 14, 2013 at 12:29 pm #

      It should be the end of this bad idea. No well baby nurseries is just plain cruel, and dangerous after a cs or long labor. Moms that want rooming in can have it, but making it mandatory is not OK.

      And for all those people that say having no help with baby isn’t mandatory for BFHI, they just need to look around to see how its actually being implemented.

      • suchende
        May 14, 2013 at 12:38 pm #

        I am so grateful my hospital resisted this bullshit. Those hours that they took my daughter out and let my husband and me sleep without jumping at all her little gasps and coos was essential to our sanity.

        • Amy M
          May 14, 2013 at 1:00 pm #

          Yeah, I had my babies 4yr ago in a wonderful hospital, which I appreciated then, but after hearing all the BFHI horror stories, I am flooded with gratitude. Maybe I’ll write to them and let them know.

          None of the nurses or other staff EVER gave me crap about supplementing or tried to convince me that formula is poison. They actually started supplementing wo/even asking me, which I did not find offensive because it was common sense—tiny 36wkers could not afford to lose much weight. I would have been offended if they with-held formula for some ideology, since that could have been very dangerous. As it was, both of them were comfortably under 5lbs when we went home.

          They took the babies to the nursery so I could sleep and OFFERED to keep them and finger feed (I was attempting to BF) so I could sleep more. Everyone was considerate and kind. I went to a BFing class in the hospital…the LC running the class simply went over basic mechanics, there was no formula bashing or ideology over all in there. I don’t know how it is now of course, hopefully, it hasn’t changed.

      • Eddie
        May 14, 2013 at 12:54 pm #

        I’m grateful that the hospital where my wife delivered implemented only the reasonable subset of this, and not the crazy parts. They have a well baby nursery, but the baby defaults to sleeping in the same room as mom. If mom wants the baby to sleep in the nursery, then that is where baby sleeps. There was no pushing of exclusive BF. They didn’t lock up the formula. There was no fear of interventions during labor. They had a birthing ball and a tub, but didn’t push either one. They were just present. The mother could walk around as much as she wanted, get into any position, at least up to the point where an epidural was put into place if the mother wanted one. (I don’t know what restrictions are in place after that point, as my wife delivered quickly after the epidural was put into place.)

        The rooms are much nicer than the rooms in the rest of the hospital. My wife and I personally didn’t care about that. It just increases the cost. But it makes some people much happier or much more comfortable, so OK.

        In other words, our local hospital became friendlier without implementing an ideology.

        • Elle
          May 14, 2013 at 2:09 pm #

          That sounds like the hospital I gave birth in too. I really appreciated how “middle of the road” they seemed to me. However, I knew I wanted to breastfeed… I may have had a very difference experience if I hadn’t wanted to.

        • Seattle Mom
          May 14, 2013 at 2:40 pm #

          I delivered at a Baby Friendly hospital that did a lot “off the books” as it were. When I toured they emphasized they were rooming in only, BF promoting, lots of birthing balls and birthing bars around, etc etc etc. But the second night I was there (after CS) I apparently looked like a wreck because they recommended I take a long bath in the roomy tub and sleep for as long as I wanted while they took care of my daughter and, the horror, fed her formula if she was hungry, (they asked my permission beforehand) This was all very nice, and I thought I must look really terrible for them to make a special exception for me! However, when I tottered out of my room much later to check on the situation (since they didn’t have a nursery) and to my surprise there were about four or five babies all in their bassinets around the nurses station, and the nurses were like, which one is yours? Seems like that kind of defeats the purpose of taking away the nursery. Other things that may or may not have been Baby Friendly: they asked my permission to give her a pacifier, I got an organic swaddling blanket instead of free formula, I slept with her in my bed one night because she wasn’t tolerating the bassinet (the nurse tucked her in), I could have had a VBAC and I had an LC come visit even though everything was going fine. For those around Seattle, I delivered at Group Health.

  22. me
    May 14, 2013 at 11:29 am #

    The only issue I take with this is that you seem to be implying that if babies don’t receive supplementation in the first few days, that they *will* be screaming in hunger, no exceptions. While certainly some babies need more than colostrum in the first few days, and some mothers’ milk takes longer to come in than others, the idea that every single baby NEEDS supplementation is not only untrue, but it could, theoretically sabotage bfing. Yes, some women can, and do, successfully combine the two feeding methods. And some can’t. Using loaded language (you’ll be forcing your child to scream for hours due to starvation if you don’t give formula on day one) doesn’t help any more than the loaded language extreme lactavists use. Better training for staff, better education for mothers, letting everyone know how to tell when colostrum alone is not enough and how to supplement without reducing milk supply would be best. The idea that routine supplementation addresses any of the concerns you discuss (pain, low supply, difficulty, inconvenience) is laughable. In some cases it could make these problems worse.

    Of course, being reasonable doesn’t increase the hit count, so, well, I know this will fall on deaf ears….

    • Gene
      May 14, 2013 at 11:40 am #

      Actually supplementation does address those concerns. Giving formula as a supplement to give your cracked and bleeding nipples a chance to heal, to give nutrition to a baby when your supply is low, to give supplementation when you or baby are having trouble with breastfeeding, to allow your baby to eat when it is inconvenient for mom to feed (like taking a nap after a difficult labor).

      Not every single baby NEEDS supplementation, true. But the idea that supplementation with evil evil formula will “sabotage” breastfeeding is, indeed, laughable.

      *signed, a doctor who breastfed her kids for over a year each, never supplemented, and teaches mothers how to latch IN THE EMERGENCY DEPARTMENT if they ask.

      • auntbea
        May 14, 2013 at 7:17 pm #

        I assume they did not come to the emergency room just to receive breastfeeding support?

        • Sue
          May 14, 2013 at 9:16 pm #

          They don’t come exactly for that reason, auntbea – they come in desperation with a baby who is “always crying” and they don’t know where else to turn. Much of emergency medicine for babies involves parent-craft skills, AFTER excluding medical causes for the crying. I’m so much better at dealing with this situation than I was before I went through it myself!

          • auntbea
            May 14, 2013 at 10:25 pm #

            Aw. Those poor parents.

      • me
        May 14, 2013 at 9:37 pm #

        I don’t know about you, but I would think cracked, bleeding nipples would take more than a day or two to heal. If you give formula until they heal, wouldn’t your milk dry up by then? If you continue nursing while supplementing, what “break” are you really giving you nipples? Honestly, I just don’t see how formula “heals” nipples; does it have magic properties that, when applied to the nipple, closes open wounds? If so, they really should consider marketing it for that purpose.

        If your supply truly is low, okay, you may need to supplement. But supplementing won’t increase your supply. If anything, it will decrease it (by how much will vary). If you supplement as a “solution” for low supply, well, seems to me you might as well call it “switching” rather than “supplementing”. And since this post seems to be dealing specifically with the early PP period, how do you even know you have low supply? If your milk hasn’t come in yet (say your on day 3), isn’t it a little early to say “low supply”? Sure, some babies need more than colostrum, but that doesn’t mean their mother has low supply and it certainly doesn’t mean formula is a solution to low supply.

        If you are having difficulty establishing bfing, how is less practice going to help? If the supplementation comes with truly knowledgeable, well trained support to help *fix* whatever the difficulties are, okay. If it comes with nothing else, well, let’s not call is “supplementing”, let’s call it what it is – “switching”. (don’t get me wrong, if a woman doesn’t want to bf, that’s certainly her choice, but if the “support” she gets is a couple of bottles of formula and that’s it, is she really making a *choice* at all?)

        As for convenience, it seems to me that supplementing represents the most inconvenient of the methods (well, except maybe exclusively pumping) – you are dealing with all the hassle of learning to bf, while simultaneously dealing with all the hassles of ffing. Doesn’t sound convenient in the slightest. Maybe while you are still at the hospital, where the nurses can feed the baby for you, but once you go home (usually between 24-72 hours) you’re on your own.

        Again, better training for hospital staff, better education for mothers, solutions to bfing issues *that actually solve those issues* (rather than just putting them on the back burner) – these things can help determine who needs to supplement, the best way to supplement (for mothers who wish to continue nursing), and help woman achieve whatever bfing goals they have set for themselves, without compromising their babies’ health and well being.

        Of course, formula doesn’t address the real barriers to bfing (and, fwiw, neither do the lactivists or the BFHI) – we need more maternity leave (paid), better health care, better, more affordable day care, and more protections for those who NIP.

        • guest
          May 15, 2013 at 4:01 am #

          i think you need to use your imagination more. Think of a mom whose milk supply is low because she is temporarily sick. She gets better and can urse again. in the meantime – formula. Think of a mom with cracked nipples who can squeeze a bunch of milk out in the shower in order to keep her supply up, but who can’t nurse or pump without paina and more damage. in the meantime don’t stress out and use formula. Think of the baby who panicks and cries inconsolably at the breast because he is so hungry and can’t get a latch. I had good luck by starting such a baby off on a bottle and then switching to the breast once he relaxed. I think all of the scare-info about nipple confusion is really exaggerated. After reading breastfeeding books, the list of things that I thought I had to do or worry about was really ridiculous.

          • me
            May 15, 2013 at 12:41 pm #

            Yes. In those specific cases, supplementation may be warranted, and even “save” the bfing relationship. But in general? Supplementing in the first few days has the potential to set you up for supply issues, latch issues, and other problems. No, women who want or need to supplement shouldn’t be made to feel bad about it (I tend to agree w/ dr amy about the BFHI), but going the other extreme and making women feel like they are somehow torturing their babies if they only offer colostrum in the first few days isn’t any better.

    • guest
      May 14, 2013 at 11:49 am #

      i think this article resonates with moms who exhaustedly paced the halls of the maternity ward with a hungry, crying newborn and the only advice or assistance given was to be told to shove a non-milk producing boob in his mouth, the effect of which tended to be more crying and not less. it also resonates with those who wasted a lot of time, money, and energy on pumping in the stinky bathroom at work, only to learn that not pumping for a feeding or two didn’t put so much as a dent in the milk supply and that breastmilk isn’t the magic elixer that they were told it was. i still encounter moms who are wracked with guilt that they quit pumping at 6 mos, convinced that their baby will get excema and be stupider as a result. the science just doesn’t bear this BS out.. but it is everywhere! and it is time to set the record straight.

    • The Bofa on the Sofa
      May 14, 2013 at 12:02 pm #

      The only issue I take with this is that you seem to be implying that if babies don’t receive supplementation in the first few days, that they *will* be screaming in hunger, no exceptions.

      How do you get that? Aside from the fact that Dr Amy isn’t talking about babies who aren’t screaming in hunger (not mentioning them does not imply that they do not exist – she isn’t talking about them), nothing anyone ever says should be interpreted as “no exceptions.” Sheesh.

      • theNormalDistribution
        May 14, 2013 at 12:21 pm #

        You know what I love about this blog? By the time I get around to pointing out why something someone said is illogical, 90% of the time, someone else has done it for me. You guys are crazy awesome.

      • me
        May 14, 2013 at 9:23 pm #

        How do I get that? from this:

        “…lactivists insisted that supplements sabotage breastfeeding and advocate letting babies scream for hours in hunger until a woman’s milk comes in?”

        Sorry, but this implies that all babies will “scream for hours in hunger until a woman’s milk comes in”. Now, do some babies need more than colostrum? Sure. Does the transitional milk sometimes take more than a few days to come in? Sure. do babies (or mothers) sometimes have issues immediately after delivery that makes supplementing a good idea (for reasons other than “screaming for hours in hunger)? Absolutely. But Dr Amy’s statement suggests that if you wait until your milk comes in, you are basically torturing your baby. Sorry, that’s bull. For many babies colostrum alone is indeed enough. Supplementing certainly has its place, but insinuating that any woman who doesn’t supplement is starving/torturing her child is grotesque.

        • suchende
          May 14, 2013 at 9:27 pm #

          Careful when you say someone’s statement “implies” something. Often, it means you’re reading between the lines to infer a statement the author isn’t making at all. Like I said before, it’s a common mistake when we’re talking about populations, to assume the author is making a more sweeping statement about individuals than they are.

        • Eddie
          May 14, 2013 at 9:30 pm #

          If you read into Dr Amy’s quote, above, that she is talking about all babies, then you are adding that into what she wrote. It’s not there. Let’s try this logic:

          1. Some babies need more than mother can produce in the first days. Depends on the mother and baby.

          2. If those babies don’t get fed more than mother can produce, they’ll be very hungry.

          3. Some of these babies will scream for hours in hunger.

          4. Some lactivists assert that supplementing these kids with formula will sabotage breastfeeding, so the mother should NOT supplement.

          Therefore, “lactivists insisted that supplements sabotage breastfeeding and advocate letting babies scream for hours in hunger until a woman’s milk comes in” Does that make more sense? You are adding in the absolute. It is not there.

          • me
            May 14, 2013 at 9:43 pm #

            I’m not sure. It seems to me that a newborn who isn’t getting enough to eat is more likely to be very sleepy than to be screaming for hours. A very sleepy baby that isn’t nursing often enough may very well benefit from supplementing until the bfing issues are resolved. A baby that cries a lot, but is otherwise healthy, gaining weight, and having adequate output? I’m not sure supplementing is the best course there (obviously, if the mother is concerned the child should be evaluated, and the mother certainly has the right to choose to supplement even if it is found that nothing is wrong). Some babies cry more than others. Sure, if that baby is bfing, we tend to blame the bfing. If that baby is ff, we don’t usually blame the formula….

          • Eddie
            May 14, 2013 at 9:57 pm #

            Sorry, I was just going through the logic. I personally cannot attest to whether or not first-week babies will cry from hunger or not, so I won’t, either way. I’m not a doctor. If a friend of mine came to me in the situation you describe (screaming baby, either BF or FF, otherwise healthy, gaining weight, etc) I would say, “get evaluated” rather than “supplement,” simply because I am not a doctor, other signs say the baby is getting enough food, and I’d want the mother to get expert advice. There could be a different problem.

            The point — if you read what others are saying about their own experience — is that plenty of mothers whose babies are provably not getting enough milk are told by lactivists not to supplement. The “screaming in hunger” may be metaphorical rather than literal in some cases. I honestly cannot say. But the “hungry” is obviously true in these cases and it’s terrible for a lactivist to essentially tell the mother to starve her kid.

          • nomorequestionscatherine
            May 15, 2013 at 9:13 am #

            “Some babies cry more than others. Sure, if that baby is bfing, we tend to blame the bfing. If that baby is ff, we don’t usually blame the formula….”

            I think this is not entirely true for all though it may be your experience.

            I know many women who have had formula blamed for their child’s crying. Usually related to supposed or potential gas pains/stomach upset because they “poisoned” their baby’s GI system with something other than breast milk. This usually sends to woman on a search to try out multiple types of formula, esp the “sensitive” variations out there, in a quest to find one which will be more agreeable to their baby whether or not it actually was the cause of the crying.**

            Sure breast milk/BFing gets blamed too. Is something in the mother’s diet an allergen for the baby and passing through the breast milk ? Is the baby not getting enough? Etc

            I just don’t think it’s as cut and dry as “BFing is generally blamed as the cause of infants crying while formula is usually not” (to paraphrase). I think the situation of what type of blaming is done depends on the people involved in each particular situation and their own bias.

            ** Note: I am not suggesting it is wrong to try a different formula if your baby seems to be having issues with the one you are using. And sensitive versions and other alternatives like soy and hypoallergenic formulations can be very helpful & necessary for some babies. My own son needed a hypoallergenic one. And since we combo fed I also had to follow an elimination diet, ha! We got it from both sides 🙂

    • Eddie
      May 14, 2013 at 12:03 pm #

      Dr Amy nowhere says that *all* babies will scream for hunger, no exceptions. You’re reading her post in an illogical either-or fashion. You’re adding extremism that isn’t there.

      *Some* babies do scream for hunger, and *some* lactivists say that the kids should not be supplemented. That is just true. Do you argue with that fact? Do you believe it’s appropriate?

    • suchende
      May 14, 2013 at 12:42 pm #

      If NO babies receive supplement, SOME babies WILL cry in hunger, given a big enough population. It’s a certainty. This sort of misunderstanding seems to arise whenever policy makers and individuals meet.

  23. Eddie
    May 14, 2013 at 11:02 am #

    I understand lactivists pushing to increase BF rates. What I don’t understand is the desire to push EXCLUSIVE BF. It’s not like formula is some terrible anti-immune-system “chemical” that seeks out breast milk antibodies and destroys them.

    As you say, it’s absolutist and ideological thinking that drives this. Being open to evidence means being open to nuance and mixed solutions. Being open to grey rather than black and white. People who think in an absolutist fashion are not open to small changes in their thinking, because they don’t realize it’s an option. ANY change in thinking is overwhelming to them.

    I’ve known people prone to these kinds of thinking, and they careened from ideology to ideology without ever going through any middle ground. It’s just like how so many people reject their parent’s parenting style, so go not to the middle ground, but to the opposite extreme.

    • LibrarianSarah
      May 14, 2013 at 11:47 am #

      Ironically, I think one of the most prevalent extremes of our time is the extreme of “the middle ground.” This idea that if two sides are saying contradictory things then they are obviously both extremists and the right answer is somewhere in the middle. You see this with the people who delay vaccination. If you have one side saying not to vaccinate at all and another side saying to vaccinate though the CDC schedule then they automatically think that delaying vaccines in the answer because it is in the middle of the two “extremes.” It’s lazy thinking at it’s best. A true pro-vaccine extreme doesn’t exist. Nobody is saying “vaccinate even if you are severely allergic, or have a compromised immune system.” I’m not saying you think this way. I don’t think you do but the golden mean fallacy really gets my goat because those who engage in it are so smug.

      • Eddie
        May 14, 2013 at 11:59 am #

        That’s a really good point. Unrelated to my point immediately above, but on topic for this post. IMHO, some of that thinking is purposefully used by extremists to draw the discussion in their direction. (Thus, the smugness.) Unfortunately for those people, and the rest of us in the vax case, there really is an objective reality and it doesn’t care what we think.

    • Sue
      May 14, 2013 at 9:18 pm #

      Eddie – I also don’t get the “exclusive” bit – but the studies that show benefit only seem to show it for at least six months of “exclusive” BF. I’m with you – it’s not as if the formula contains antibody destroyers.

    • nomorequestionscatherine
      May 15, 2013 at 9:32 am #

      “I understand lactivists pushing to increase BF rates. What I don’t understand is the desire to push EXCLUSIVE BF.”

      Because this validates their decision to exclusively breastfeed and keeps the image of formula as a “poisonous chemical” or whatever nonsense they’re spinning about it ATM out there for women to be faced with (guilted with?) when they’re potentially trying to make a very difficult decision about how to feed their baby. The extremists love nothing more than to be validated in the decisions they made and if that also has the side effect of putting down others who made a different choice then yay for getting 2 birds with 1 stone.

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