Help me end the Baby Friendly Hospital Initiative before more babies and mothers are harmed

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Dear Neonatologists, Pediatricians, Neonatal Nurses, and the organizations that represent them:

Please help me help babies and mothers. The Baby Friendly Hospital Initiative is killing babies and you’ve got to stop it.

Nearly every day I get another email or Facebook message about a baby who has been injured seriously or even fatally by the Baby Friendly Hospital Initiative (BFHI). And it’s not just mothers who are writing to me. It is postpartum nurses, neonatologists, pediatricians and other physicians who can’t believe what they are witnessing and seek my assistance in publicizing it and putting an end to these preventable tragedies.

Babies are being harmed and even die, yet the physicians and nurses who care for them feel powerless to help them in the face of the BFHI.

In the last few months I’ve heard about multiple infants sustaining skull fractures by falling from their mothers’ hospital beds, multiple infants who have suffered brain damage from dehydration and greater numbers of hospital re-admissions to treat dehydration before it leads to permanent injury, and countless cases of poor weight gain and failure to thrive.

Babies are being harmed and even die, yet the physicians and nurses who care for them feel powerless to help them in the face of lactation professionals who have seduced hospital officials with the promise of saving money by implementing the BFHI.

What is the Baby Friendly Hospital Initiative and how is it hurting babies?

The BFHI is a hospital credential that is given to institutions that can demonstrate that they follow the ten steps of the initiative (and have given a big slug of money to BFHI to pay for it). It’s meant to encourage breastfeeding though there is evidence that it doesn’t even work.

You can find the Ten Steps here. The most dangerous steps are these:

  • Give infants no food or drink other than breast-milk, unless medically indicated.
  • Practice rooming in – allow mothers and infants to remain together 24 hours a day.
  • Give no pacifiers or artificial nipples to breastfeeding infants.

This despite the fact that:

We KNOW that 5-15% of mothers will not produce enough breastmilk to fully nourish an infant.
We KNOW that judicious formula supplementation in the days after birth INCREASES breastfeeding rates.
We KNOW that there is no evidence that rooming in has ANY impact on breastfeeding rates.
We KNOW that there is NO EVIDENCE that pacifiers or artificial nipples reduce breastfeeding rates.

And most importantly:

We KNOW that the benefits of breastfeeding term infants in industrialized countries are SMALL.

No one can point to even a single term infant whose life was saved by breastfeeding whereas we can now point to many infants lives that have been destroyed or ended by letting a special interest group control infant care. And that doesn’t even take into account the suffering of mothers forced to endure their babies’ screams of hunger and are deprived of desperately needed sleep by the closing of well baby nurseries and enforced 24 hour rooming in.

Lactation professionals and the breastfeeding industry mean well. They honestly believe, in the face of copious evidence to the contrary, that breastfeeding has nearly magical health benefits, and that virtually any risk is worth taking to enforce breastfeeding among new mothers. But they aren’t medical professionals.

Neonatologists, pediatricians and postpartum nurses are medical professionals, and as such, are charged above all with ensuring infant well being. Outcome (a healthy baby) is far more important to medical professionals than any specific process like breastfeeding.

Neonatologists, pediatricians and postpartum nurses should immediately institute three specific measures:

  1. Easy access to infant formula and a low threshold for supplementation in the first few days.
  2. Routine access to pacifiers to soothe babies who are comforted by them.
  3. Mandatory access to well baby nurseries where every mother can send her baby for large blocks of time so she can sleep.

I don’t doubt for a moment that the breastfeeding industry is sincere in its beliefs, but babies are being harmed by those beliefs. We are experiencing an upsurge in serious adverse outcomes like infant skull fractures, severe neonatal dehydration, and even smothering deaths of infants left to sleep in their mothers’ beds because of forced rooming in. We should be tracking those adverse outcomes and doing everything in our power to prevent them.

I know that it is difficult to buck the hospital administration when it finds intellectual cover for financial decisions like closing well baby nurseries by insisting that it will boost breastfeeding rates. But babies have no one to defend them besides neonatologists, pediatricians and postpartum nurses.

Please, please stand up for them.

  • Simon Pound

    I promote and support breastfeeding. However, to listen to the cries of newborn ravished with hunger is heart-wrenching and to listen the next day when that same infant’s cry sounds hoarse, I want to cry. I want to advocate for that child and say just give them 10-15 ml of formula, I promise that baby will breastfeed in 3 hours, you won’t mess up any blessed thing. I believe it’s neglect to make a child starve until your milk supply comes in. If I gave drops of food to a baby you would think the same thing!
    Post-partum nurse
    10 years

  • Cidalia Martins

    I would like to see an end or at least an overhaul of the Baby Friendly Initiative. I almost killed my daughter because of the bad “professional” advice I got from nurses and lactation consultants (some who even came to my home). Advice that went against my own instincts and observations. My daughter almost died from dehydration and malnutrition while these idiots assured me that all was fine. Formula feeding was what ultimately and literally saved my daughter’s life and enabled us to resume and continue breastfeeding successfully for almost 3 years, contrary to bad advice I got.

    • MaineJen

      Wow…sadly, we are learning this is all too common.

  • Kazine Phoenix

    You are delusional.

  • Nick Sanders

    Oh look, 3 unregistered commenters all saying nearly the same thing in the space of less than half an hour. What a coincidence… :eyeroll:

    ETA: I would like to say to our three drop-ins, that this is an ongoing blog. Few, if any, posts are meant to be taken in a vacuum, but instead build upon previous posts. Dr. Tuteur has indeed provided the evidence you are asking for, in multiple previous posts. As this is an informal, rather than formal, publication, she is under no obligation to restate her citations with every new entry.

  • Kay

    Where is your evidence for the things we “know”? Where is your evidence for your claim of newborn deaths?

  • Lindsay

    Can you provide references to peer-reviewed papers and systematic reviews to back up your article please?

  • Hannah

    Hard to believe you’re medically qualified. Please cite your references to the scientific research to support anybody these claims. Perhaps then I might think about considering your bilge.

    • Charybdis

      Are you medically qualified, because then *we* might consider *your* bilge.

      • Amazed

        *I* won’t. Everyone can say they’re medically qualified. If she has the knowledge of Addi, Megan, CanDoc, fiftyfifty1 and our CNMs here (I am sure I am forgetting someone for which I apologize), she’ll first have to prove it to me.

        • Charybdis

          I’m in the same boat with you, really. I was returning snark fire…

  • Lieve

    breastfeeding DID save my son’s life over 12 years ago. doctors on intensive care gave all medication they could, but fresh-pumped breastmilk was the trigger to turn the negative flow he was in.

    • Azuran

      Could be, could also be a coincidence. But if your baby had not made it it definitely would not have been because formula is bad for babies.
      I am sorry you had to go through the hell of having a sick newborn baby and it’s awesome that he made it through. However, you cannot extrapolate the needs of a sick newborn to those of healthy terms babies.
      Practically everyone here agrees on the health benefits of BM on premature babies and potentially on mature but very sick babies. But that’s still no reason to shame mothers for their feeding choices when it makes no difference for their baby.

    • CSN0116

      Breast milk outperformed medication in a life threatening situation? I beg you to give details on that event

      • Lieve

        Outperformed? Not really. He needed all that medication too. But it didn’t enough. And it was the choice of the doctor in intensive care to give him fresh pumped breast milk in a last try to save him.
        My son was born with a congenital heart defect, which we didn’t know until he got bronchiolitis when he was 7 weeks young. I got sick too, a few hours later then him. He needed ventilation so he was transferred to a bigger hospital but his saturation still was bad. A cardiologist came and saw the rare heart defect. He needed urgent operation but that was impossible because of his lungs. In the days following, his condition was that bad that doctors told us he was about to die because of heart failure. They weren’t able to get the (viral) infection of his lungs under control. As a last chance they would try to give him a bit of the breast milk but we had to prepare for the worst. As i pumped my milk and stored a bit in the hospital (before i even didn’t know that was possible) and i was about to give up on that because i was very ill too at that time and i needed medications myself -sinusitis and pneumonia so i had to throw away the next milk because of the medication i really needed) so i asked to give him my last fresh milk.
        2 hours later his situation began to stabilize and in the hours following, it was even possible to lower oxygen. It was just a miracle. Doctors told me that the breast milk did just that little extra he needed. It took another 10 days to be strong enough for surgery but he survived.

        • Who?

          It’s great he’s okay, that must have been a terrible time for your whole family.

        • guest

          Perhaps it was the breast milk, or perhaps two hours later was just the timeline for his turnaround. There’s no way to tell. I’m glad things worked out well for you, but please don’t hold this up as an example of why BFHI should continue to harass mothers and put babies at risk of death from falls and suffocation.

        • fiftyfifty1

          Why did he get bronchiolitis in the first place if breastfeeding is so miraculous?

          • Sarah

            Hatting.

          • Mary Judge

            Good question…

    • corblimeybot

      What’s negative flow?

    • guest

      The breastmilk did what with the who now?

    • Mary Judge

      Really? That’s great! My grandson could’ve died from being breast fed and my daughter DID almost die. Her appendix burst in the hospital and no one knew. Her OB-Gyn, the lactate idiot specialist and her complete medical after care were so hands off. In the hospital they gave her morphine for the pain and told her it was up to her to feed her son. He in the meantime lost a pound and half. They sent them both home anyway, she had a low grade fever and was in terrible pain. They made her feel terrible but at least she was clever enough to compensate with formula. On the third day, being at home she phoned me, I took her to her dr. (whom I now call dr. hands-off) he said to go to the hospital (didn’t bother to call it in as an ’emergency’.) Her appendectomy operation took over three hours because she was in sepsis, turned out the general surgeon said her appendix burst while giving birth. I am thrilled that Dr. Tuetur and so many other doctors are coming to the conclusion that breast feeding is not the end all and at times could kill an infant. And; yes maternity wards must start being more attentive to mothers, why would any critic here have a problem with that. Glad your child is fine and breast feeding helped him. Horrified that you and a bunch of your friends are willing to put down a doctor for fighting for women in similar predicaments as my daughter and so many other women are in. Breast feeding is great when the conditions are appropriate, when they’re not it could be deadly.

  • Dr Kitty

    nikkilee,

    I have two children, six years apart in age, both born at 39 weeks by planned CS. Both 9th centile on growth charts at birth and 25th centile at six months.

    I breast fed both without difficulty- good latch, good supply, no issues at all.

    But babies are not identical.

    My daughter slept through the night from five months, started solids at 6 months, largely refused bottles of EBM and was quite happy nursing only three times in 24hrs after six months. She never had a drop of formula, and I continued BF until she was over a year (16months- something like that).

    My son still wakes once or twice a night to feed at almost 9 months. He started solids at 4 months which led to a temporary improvement in his sleep, but then he started crawling at 6 months and the sleep and feeding schedule went to pot.
    He was taking 3 spoon feeds, breastfeeding 2 hrly between 8pm and 8am and 3 times during the day AND I was having to pump twice a day to get milk for his childminder (he was quite happy to drink EBM, and was guzzling 12oz a day).

    So, there I was feeding him 8-10 times every 24hrs, plus 2 pumping sessions, and both of us were losing weight, tired, grumpy and hungry.

    When I hit 40kgs I decided to cut the pumping sessions out and send him to his childminder with 12oz of formula. He also gets a 4oz bottle of formula with his dinner. At nine months he is still getting breastfed 3 or 4 times a day and when he wakes at night (down to once or twice…mostly), and eats three solid meals and two snacks a day.

    There was no difference in my supply, or support system, or goals.
    But I had different babies- one who didn’t crawl until almost a year, and just didn’t need as many calories and one who has been mobile since six months and DOES NOT STOP MOVING. He’s started pulling to stand and creeping along holding onto furniture in the last week, so I imagine he’ll be walking well before he turns 1.

    What would have been gained by continuing exclusively breast feeding him? Not on a population basis, on an individual basis- why would it have been better for me not to give him formula?

    I called time when we were feeding every 2 hrs, I had lost more than 10% of my bodyweight and the baby had gone from 50th centile down to almost 9th. What support would you have offered me that would have made things better?

    • Nick Sanders

      Good to see you again!

    • Sarah

      Probably a lecture on the evils of formula companies laced with a bit of scientific illiteracy.

    • moto_librarian

      Don’t you know, Dr. Kitty? You should have quit working so you could do nothing but lay around and nurse your son. Never mind if you happen to be the primary breadwinner.

      • Dr Kitty

        Never mind paying the bills, my emotional wellbeing pretty much depends on NOT being forced to stay home and care for an infant 24/7. I chose to do it short term, but after six months I was done. I need work for my sanity.

        • moto_librarian

          I completely understand. I am not cut out to be a SAHM.

    • Who?

      I predict crickets from nikkilee.

      You do not fit her template, therefore you are not.

      • Bombshellrisa

        She is a doctor plus her two planned (and enjoyed) c-sections. That is three strikes before she even got to the part about formula.

  • I don’t really need much more than “Breast Feeding Industry” to get some serious red flags up in my brain.

    It sounds like DIY Healthcare – like somebody sees a way to save a boatload of money by cutting the Nursing Staff, and getting the patients to pick up the slack; then hiding behind a slew of blatantly self-serving rationalizations to shift the risks away from the Hospital / Insurance Corporations, in order to duck their liability.

    These Rent-Seeking Suits have no soul and no honor.

    • nikkilee

      You are right. And it has been so since Nixon made medicine a business.

      • guest

        A business that you are a part of.

      • The Computer Ate My Nym

        Nixon made medicine a business? What was it before that?

        • Charybdis

          A profitable hobby? A noble calling?

        • MLE

          It’s always such a relief when the “enemy” is something or someone so outlandish that you know you don’t need to marshal arguments against it. It’s a huge load off.

      • Who?

        A bit rich you mentioning that in a slightly pejorative tone when we consider your very business-like website flogging your many-ahem-‘services’.

      • momofone

        One from which you don’t benefit at all, right?

  • Bombshellrisa

    Just putting this up at the top: out of 27 hospitals in my state that have an L&D, only one MAY have a well baby nursery. It’s a five bed L&D. I haven’t checked every hospital, so there may be more well baby nurseries but none at the big hospitals.

  • momofone

    My son was born in the same hospital I was. When we went for the tour, I told my husband I was fairly sure nothing had changed, including the nurses, in the almost forty intervening years. I was furious during the tour when the nurse told me that my son would not be allowed to spend the night in my room for nursing; he would stay in the nursery and be brought to my room to be fed. Between the hours of 10 am and 10 pm he would be in my room, but at 10 p the nurses would take him back to the nursery so that I could rest. He was not allowed to be in my room if I was asleep. I was all into the breastfeeding woo, and did not want him to have sugar water (which she said was standard) or pacifier, because I was so afraid that either would doom our breastfeeding relationship. My husband made little signs that said “I’m learning to breastfeed; please take me to my mom instead of giving me a pacifier.” (I know, I know.) I was taken aback by how old-school the whole setup was. And then my son was born, and we had unforeseen complications. I wasn’t able to hold him for 24 hours, and it was quick; he had hemolytic anemia and severe jaundice and had to go back to his special care bed almost immediately. I wasn’t able to even try to breastfeed for almost a week, so I was pumping every hour and a half and trying to sleep in between, and see him every time they would let us in. The nurses gave him what I pumped, but also gave him formula, because he needed it. He had a pacifier, and as it turns out, he loved it. The nurse I was so upset with made a special concoction to help with his awful diaper rash and took equally good care of my son’s scared, exhausted parents, making sure we slept and ate. All of that to say that I had no idea how fortunate I was to be in a place where my well-being was considered just as important as my son’s, and where my being able to sleep was considered a priority by the people caring for us. I would never have said this then, because I was too ignorant to know how well I had it, but thank goodness we didn’t have to deal with the BFHI.

  • sara

    As both a family practice physician who has seen patients bullied and a soon to delivery my first at a *sigh* baby friendly hospital, I’d love some specific ways to do this – somewhere bigger than my local hospital (or potentially, their PR team)? Who is the force? Newspaper editorials? Ideas? I’m not enough into the activism end of things.

    • Charybdis

      Ways to fight the BFHI edicts while you are in the hospital?

      • nikkilee

        There is formula in BFHI hospitals. Not everyone is breastfeeding. The difference is that the formula is ethically purchased the way everything else a hospital buys is purchased.

        • guest

          Since when is it ethical to make health care and hospital stays cost more on purpose?

          • Megan

            When your goal is to make sure only the desires of the privileged are met.

          • guest

            Well, there’s that. But it’s not ethical in my view, and that includes cutting off free formula samples that really help some poorer families.

        • AllieFoyle

          I think we all know there is a bit more to it than that, nikkilee. Let’s not be disingenuous here. Formula is technically there, but many women have difficulty accessing it without lecturing, hectoring, misinformation, or judgement.

        • Sarah

          There is formula in BHFI hospitals, yes. The issue is with whether women will be allowed to use it and, if so, whether they will be permitted to do so without being subject to some jobsworth doing a big shit all over their right to accurate information and to choose. Obviously.

        • Irène Delse

          You mean “the formula is locked up and if a baby needs it, the mother had to beg for it, get misinformation, beg again, sign a formulary as if it was some controlled substance. Basically, be treated as someone irresponsible that the hospital can’t trust to make an informed choice.

          • Bombshellrisa

            It’s easier to get a controlled substance in the hospital. You ask they bring it. I never had to sign anything saying that I was poisoning myself.

          • Megan

            Yup. No one made me sign for Dilaudid.

          • guest

            One time I didn’t even have to ask. A nurse looked at me and said “You know, I can bring you another painkiller if you like.” And lo, I have not become a habitual user in spite of her offer and my acceptance.

        • Charybdis

          Ethically purchased. What does that even mean? I would assume that anything consumable in a hospital is “ethically purchased” from their contracted suppliers or directly from the manufacturer, with appropriate discounts for bulk orders. Even if formula is given to the hospital for free by the manufacturer, so the hell what? The baby must eat.

          There are only 2 ways to feed a baby: breast and bottle, or breastmilk and formula if you prefer. The baby has a right to be fed and if breastfeeding/breastmilk is not available for whatever reason, then formula MUST be used.

          Wishing it wasn’t so, making formula nearly unattainable for a new mother in the hospital and demonizing formula manufacturers as deviant bullies out to undermine and destroy the breastfeeding utopia lactivists fantasize about will not make formula vanish from the marketplace. Because what else is there to feed a newborn baby if nursing isn’t working?

          That is what sticks in the lactivist’s collective craw; there will ALWAYS be a market for formula and many, many mothers will opt to use formula, no matter how hard “breast is best!” is pushed on them. I daresay that the heavy-handed, overbearing and myopic insistence on breastfeeding in BFHI and LC’s has made a lot of women determined to never breastfeed with subsequent babies and embrace formula from the get-go.

          • nikkilee

            Formula industry gives away its product in order to make friends and sell product, aiming for brand name recognition. When parents buy the name brand used in the hospital, the industry gains another $700+/year in profit. However no formula sold, according to the FDA regulations, can be inferior to another; they all have to meet regulations.

          • Heidi

            So, my baby had a tag in his bassinet that said MEDELA on it and “I’m a breastfed boy!” And then without my consent, some Medela equipment was brought to my room. But I guess that’s a totally different thing. Oh, wait, it’s not!!!

          • nikkilee

            It’s totally the same thing.

          • Nick Sanders

            That has nothing to do with Charybdis’s question.

          • KeeperOfTheBooks

            And this is different how, ethically, from Medela giving me a free tote bag, and Lansinoh stocking said bag with nipple cream and breast pads? That bag didn’t make my milk come in sufficiently or punctually, and nor did it force me to keep breastfeeding once it became clear that it was causing both of us far more harm than good. For that matter, while I used Similac to supplement via an SNS in the hospital, I cheerfully bought generic formula for the remainder of DD’s infancy because cheaper-yet-identical.
            Again, it’s almost as though, despite the fact that I’m a woman, I’m capable of making my own decisions based on the best solution for me and mine even if someone says “oooh, free shtuff!”

          • nikkilee

            There’s no difference. Pump companies can act unethically too.

          • KeeperOfTheBooks

            But how is it unethical?
            There are a lot of companies out there that make pumps/nursing accessories, as there are several companies who make formula.
            There are also lots of companies out there that make burritos, or frozen pizzas, or protein shakes; is it unethical for a Costco staffer to say “want to try some pizza?” when you walk through the store?
            The fact that they’re nice enough to say “hey, we like our product, and we think you will, too, so have some on us” doesn’t mean they’re unethical. Quite the contrary, I should think: they’re letting you judge the product for yourself, apart from cost factors, and while you may like their product, you may also make the now-informed decision that either you don’t like their product, or that the generic version is just as good. It would be unethical for them to, say, arrange to have a law passed that only allows you to eat Sally’s Frozen Pizza, but that simply isn’t the same thing as someone offering you a bite or two of Sally’s Frozen Pizza for free.
            Come to think of it, one could even argue that it suggests a modicum of corporate responsibility to stand behind one’s product to that extent: it means that they care enough about what their public think about their product that they want feedback and that they’re willing to take a risk of people not liking it in order to get that feedback.

          • Bombshellrisa

            Spot on!!
            Come to think of it, Motherhood Maternity gave me free coupons for a nursing pillow, nursing cover and they gave away Avent bottles. Mixed message or just a nice “hey, these are things parents might need, have a couple of these things and thanks for buying ridiculously overpriced but insanely comfy maternity panties from us”.

          • Megan

            If you signed up at Motherhood, that’s how you got free formula samples. That’s how I got mine.

          • Bombshellrisa

            The mystery is solved! Well, I appreciated it. I had gotten 1 bottle of ready to feed for just in case and the samples came in handy when I was faced with an infant who couldn’t nurse. I was pretty tired when I got home from the hospital and I didn’t feel like running to the store the day after we got home. Yay free stuff!

          • Megan

            Come on, face it. You had planned to breastfeed but those sneaky SOB’s at MM colluded with Enfamil AND Similac to undermine your efforts and you just couldn’t resist the siren song of a free sample. Your milk dried up immediately as soon as you popped that baby open, amiright? 😉

          • KeeperOfTheBooks

            Oooooh, so that’s how they got my info! Note to self: sign up at Motherhood for future pregnancies, even if I don’t need much in the way of their clothes.

          • Bombshellrisa

            But those maternity pants could be used around the holidays. Think of them as thanksgiving pants

          • guest

            I love this idea. Thanksgiving pants, ha.

          • KeeperOfTheBooks

            Pie. Pie. Piepiepiepie.
            I like the way you think!

          • Roadstergal

            I try to wear my UA compression pants around Thanksgiving to slow myself down. :

          • demodocus

            I’m still not sure where Demo was signed up that *he* got the formula samples this time.

          • Monkey Professor for a Head

            Oh dear, that might stop him from breastfeeding!

          • Who?

            Some people will look for any excuse….

          • KeeperOfTheBooks

            And oddly enough, MM’s kind gift of gift cards for the aforementioned free nursing pillow, cover, a sling, and a carseat canopy did *not* persuade me to nurse this kid, any more than their gift of an Avent bottle (yay, same brand/style I use!) forced me to bottlefeed.
            In a simply *shocking* turn of events, I was able to accept the gift cards, genuinely thank the cashier, and then mail them off to a friend who, unlike me, breastfeeds/regularly babywears and was delighted to get them. I’m sure I’m the single, strongminded outlier though–no other woman would be capable of such self-control!
            I suspect that “ridiculously overpriced but insanely comfy” is MM’s unofficial slogan. 😀

          • demodocus

            m&ms…mmmmmm…

          • KeeperOfTheBooks

            With a glass of milk! *drool*
            Or in soft serve ice cream! *drools even more*

          • Bombshellrisa

            A blizzard or McFlurry-I just realized I can do that at home. I got ice cream for family dinner this weekend!

          • BeatriceC

            Buy mini M&M’s. They work better for and ice cream topper. At least in my opinion. YMMV.

          • Bombshellrisa

            Toddler and I might have to go buy those tomorrow. We are going to feed the ducks and the store is on the way home. I wonder what he will think. He likes chocolate.

          • Bombshellrisa

            I bought m&ms, you made me do it! It’s just like when there was the lasagne discussion and I ended up asking my mom to make lasagne for me.

          • Monkey Professor for a Head

            I remember those lasagne discussions, I made the best Squash lasagne after that. 🙂

            Advertising works!

          • Bombshellrisa

            I have the recipe you sent me for that!
            Yeah, I must be a weak minded sheeple. They give me formula samples, I end up using them. Free laundry detergent samples and I end up loving the brand. Someone mentions lasagne and I lust after it.

          • demodocus

            LOL

          • BeatriceC

            That’s kind of mean you know. June 7th can’t come fast enough. I’m pretty sure I can’t live without chocolate much longer (and if it is a chocolate allergy, I’m going to get very grumpy.)

          • demodocus

            Sorry. I don’t have any chocolate, either. Or ice cream. or pastry. *sniff*

          • BeatriceC

            I dunno. I took that Pampers sample and gave it away. I discovered with my first I liked Huggies better, so that’s what I used with the rest of them, despite the samples and coupons in the gift bag.

          • Mishimoo

            I loved Huggies too, but then the only store that had them ran out and so I tried the Aldi ones. No more nappyrash after the switch, so I was sold on that brand thanks to the lower cost and more comfort for the kiddos.

          • BeatriceC

            Funny how different babies do different things. Buggies were the ones least likely to cause diaper rash with my oldest. I never used anything else with the other two, so I don’t know about them.

          • guest

            “Buggies” sounds like the worst brand of diaper ever.

          • BeatriceC

            Ugh. You’d think Apple’s programmers would figure out major brand name product names.

          • guest

            Maybe they knew how much I’d need that laugh at just that moment.

          • demodocus

            I went with pampers for the first several months. Still had pregnancy nose and they had the least offensive scent to me when used

          • BeatriceC

            I don’t know about today, but at the time pampers had a plastic outside that was sticky and irritating to both the baby and me. Huggies had a more cloth like exterior which was less annoying. Plus OK got terrible diaper rash with pampers.

          • guest

            I’ve still got two in diapers and have used 6-7 different brands over the past three years. None have a plastic outside anymore (the brands I remember using: Fisher-Price, Huggies, Luvs, Pampers, Diapers.com, and Parent’s Choice). They all felt pretty much the same to me, and for whatever reason, they all worked the same on both of my kids (boy and girl). I buy what’s cheap. Luv’s are the cheapest, but they are perfumed. I hated that, but it didn’t irritation anyone’s skin so we used it. Other than that, the main difference seemed to be the print on the outside. Plain white is hard to get! Most of them are branded (gasp! advertising!) with cartoon characters.

            Anyway, the only things that influenced my choice of diaper were: A) low price B) no leakage, and C) no diaper rash. As long as those three conditions were met, no amount of advertising wetness indicators and whatever else mattered. If I had more money, I’d’ve tried the ones that claim to have less of an environmental footprint.

          • Box of Salt

            ” Luv’s are the cheapest, but they are perfumed.”

            I bought them once. After I opened them, I had to spread the whole pack on my patio to air out before I could bring them back inside my house. And they still stunk.

            No amount of cost savings would entice me to buy their brand ever again.

            They also leaked for my kid. This was back in 2006 or 2007 when they had a money back satisfaction guarantee. I used maybe half of them (until I had the opportunity to go back to the store and get something else) and got my money back. They discontinued guarantee shortly afterwards.

          • guest

            The smell really is awful. And why is the cheapest brand the perfumed one? Surely Luv’s could eke out a little more profit by not buying the fragrance. The Fisher-Price diapers are harder to find, but they were one of the cheapest and worked well. Those were my favorite. Diapers.com was the go-to, though, because it’s hard to beat reliable next-day delivery when you have twins, but you don’t have a car.

            Anyway, when I can manage it, I don’t buy Luv’s, but sometimes cash is tight and toddlers are pooping and resisting potty training, so…

          • demodocus

            Definite change in diaper styles, none I’ve tried have been sticky at all, but then your babies are a few years older than mine.

          • Charybdis

            We were Pampers all the way. I tried Huggies and Luvs, but the Pampers fit DS better and he didn’t get diaper rash with them. He did with Luvs (really bad) and milder cases with Huggies. I used a lot of what I called “The Whip” butt cream with him. It was a mix of zinc oxide, Mylanta and a little bit of athlete’s foot cream. Worked like a charm and cleared up his worst rashes damn near overnight.

            It’s that sensitive redhead skin…

          • nikkilee

            It is unethical because nothing is free in a hospital, not even an aspirin. It is not ethical to treat one product differently. Free samples are a marketing strategy. The mission of hospitals is to give healthcare, not marketing.

          • KeeperOfTheBooks

            As I understand it, the hospitals aren’t funding the formula samples or the breastfeeding gift bags; the companies are. These are items that new moms can and often must use: a breastfeeding mom will often leak in the early days (and sometimes later), or need a breastpump (I got a free manual Medela), while formula-feeding moms may very well want to try different brands and see which one Junior does best on without dropping $25+ for a container of the stuff only to find that Junior spits up more on Infamil than on Similac.
            The options are a) tell everyone they must bring all their own supplies in anticipation of all possible events (I assumed, for example, that I wouldn’t need a pump, would nurse easily from the start, and of course, would never need formula–wrong on all counts), and if you don’t plan for every contingency, guess you and baby are screwed, b) charge everyone, many of whom can’t afford healthcare to begin with, for stuff that companies are willing to provide for free, or c) say “cool, thanks!” when a company offers to provide free samples of Useful Products, albeit without showing preference for brands of Useful Products beyond expecting them to meet a common standard–i.e., no cyanide in the nipple cream, please and thank you, and no goats’ milk instead of actual formula.
            Would you prefer that hospitals contract with a single breastpump provider and ditto a single formula provider to provide these things for the moms who need them? I wouldn’t. That would at least imply, and probably lead to, a strong conflict of interest for the hospital and the healthcare staff. Saying “hey, Lansinoh and Lact-Aid and Medela and Infamil and Similac and Boppy and who-knows-all: you want to give moms free stuff? Go for it. If one or more of your competitors also offers moms free stuff at our hospital, mom gets asked if she has a preference, and we respect it” does not.

          • swbarnes2

            So you are saying that hospitals should only use non-branded cloth diapers, because using Pampers is wrong? Is the new mom recovering from PPH or pre-e or whatever supposed to be washing them out, or are you going to do it on behalf of the nurses?

            Or do the babies just go commando?

          • Elizabeth A

            So, when the nurse in radiation handed me a fistful of samples of aquaphor, was that unethical? The pediatrician who supplied me with lanolin samples – what’s your stance on her? I’m still buying aquaphor, that stuff is a miracle. And oh gosh, that one chemo nurse who phoned me up a wound care specialist and sent me home with a stack of tagaderm dressings, no charge, what kind of monster was he?

            When my children were born, we left the hospital with a package of newborn pampers both times. Those one piece hospital pacifier’s are so awesome that they sell them in CVS now, and no one charged us explicitly for those.

          • Roadstergal

            (Tangent – I am another victim of a free Aquaphor sample. It was so unethical of them to demonstrate to me how awesome that shite is!)

          • momofone

            Then how exactly do you describe your job? Because it sounds like you market the hell out of breastfeeding. (Let me guess–that’s different.)

          • nikkilee

            Education about biologic process. . . available to most. I am one part-time grant funded LC for a whole city; formula industry made $55 billion globally last year, of which they spend 10%-25% (depending on what source you read) on marketing. Marketing means selling a product.

          • momofone

            Sometimes, as with breastfeeding, the product is an ideology.

          • Marketing can and often does mean selling an idea, not a product. You’re selling your idea, that breast is best, and you’re getting government funds to do so. How is that fair?

          • Guest

            Wait, wait, wait! When I ordered lunch trays during my postpartum stay and asked for clear soda, they gave me a NAME BRAND SPRITE!! How dare they promote Sprite over 7-up? And I got NAME BRAND Nabisco cookies. What on earth were they thinking trying to manipulate my food choices? In damaged forever!

          • nikkilee

            Infant feeding choice versus choice of soda are two completely different things. One is a matter of health and the other isn’t.

          • demodocus

            True, drinking nothing but soda is bad for you, but a 3 month old drinking nothing but formula or breastmilk is exactly what they’re supposed to be doing to be healthy.

          • Elizabeth A

            But the store brand soda is cheaper, and the overall profits of the soda industry increase when hospitals buy name brand soda. Why isn’t the hospital going to Costco for store brand ?

          • Roadstergal

            I don’t know how I missed this comment, but it might be the first true thing nikkilee has posted – but completely backwards. Sugared sodas are indeed a health concern, as they can contribute to health issues in those pre-disposed to obesity, diabetes, and metabolic syndrome, and therefore choosing a sugar-free option is indeed a matter of heath. Whereas feeding properly prepared formula vs ideal breastmilk*… isn’t.

            *Yes, I’m making that caveat. If there isn’t enough milk, if it’s too watery, if the baby can’t efficiently get it out or keep it down, etc., it’s worse than formula. Compare like to like.

          • Charybdis

            Formula is FOOD, the fact that you don’t want to treat it as such is beside the point. It is no different than the liquid food they use to feed people with a feeding tube, except that it is going into a baby via the oral route.

            My doctor gives me samples of prescribed medication so that the pharmacy bill is not as big, nor am I constrained to the artificial limits placed on prescriptions. (I would get a big bag full of various triptans for my migraines when we were hunting for something that would work: injectable Imitrex, Amerge, the powdered one you mix with water, etc) and I’ve been given cough syrup samples, Singulair samples for DS, etc.

            The dentist hands out free toothbrushes, toothpaste samples and floss samples each time I go for a cleaning.

            Hospitals DO provide health care, but often times that care is transferred to the patient when they are discharged and by providing the patient with enough supplies so they can survive a couple of days while they are getting prescriptions filled, products bought (crutches, braces, bandage supplies, nutrition shakes/supplements, etc) just seems like a good idea. You then have extra, in case of emergency, or have enough to get you through a short span of time until permanent measures can be put in place.

            Hospitals have to get their supplies from somewhere, and giving patients extra is NOT a bad thing.

          • Angharad

            When I left the hospital with my daughter, I received (for free or included with the room, but they weren’t listed separately on my itemized bill):
            A baby shirt with the name of the hospital and the words “Special delivery”
            Two nose-sucking bulbs
            A small package of newborn diapers
            A small package of wipes
            Three pacifiers
            A diaper bag
            The hat my daughter had been wearing
            A sample of the narcotics I was prescribed for pain
            Coupons for diaper cream, wipes, and diapers
            and
            Five 2-ounce ready-to-feed bottles of formula
            Please advise why only the formula was unethical to provide for free, or what could have been gained by making me pay for all the other items I received.

          • nikkilee

            Parents don’t pay; their insurance does. Hospitals often bundle charges so insurance pays one big fee.

          • momofone

            Are you saying that hospitals are charging insurance for the samples provided by formula companies?

          • Irène Delse

            This is not what Angharhad was asking. Why do you change subjects? Here, let me remind you: of the various samples and coupons from the hospital, why single out the formula? Why aren’t you incensed about diapers and wipes (think of the environment)! Why not the coupons, where the parents are supposed to make actual purchases to redeem (pushing consumerism)! And so on.

          • nikkilee

            Because hospitals should be marketing health, not being used by industry to sell product. Because free formula samples undermine breastfeeding: this is a research conclusion and the reason that industry gives the samples. Because hospitals buy food: eggs, orange juice, so they should buy formula.

          • Azuran

            And formula is a perfectly good and healthy way to feed a baby. Supporting women who want to formula feed is a healthy practice.

          • guest

            Meh. Free samples of Lansinoh nipple cream and pump flanges doesn’t undermine bottle feeding. Get over it already.

          • momofone

            So should they stop doing breast reconstruction (and therefore being used by the implant industry to sell product) and instead insist that their patients with breast cancer should just be healthier?

            I really wanted to give you the benefit of the doubt, but clearly I have done that in error. You do not listen, because what you hear would force you to question the line you’ve swallowed–and marketed the hell out of–and you are not willing to do that.

          • guest

            Let me get this straight: If an egg distributer exec wanted to do something charitable and approached a hospital about donating some amount of eggs to help lower their food costs, the hospital should turn this down as unethical?

            That’s just twisted.

          • CSN0116

            Undermine = damage or weaken.

            How does the presence of formula damage or weaken the physical act of breastfeeding? Do you mean it’s a convenient out when women realize what a pain in the dick breastfeeding is? So what?

            You people talk about formula like crack. If you have to breastfeed with a blindfold on and earplugs in as not to be wooed away, then that shit isn’t all it’s cracked up to be. The “exclusively breastfeed or bust” rhetoric is really tired. More women would nurse if they were taught that combo feeding from birth is totally acceptable and possible.

          • Who?

            I started to reply to nikkilee but you said it all, only more pithily that I would have.

          • demodocus

            “breastfeed or bust” giggles like a junior higher

          • demodocus

            My love of the Red Sox has been undermined by the Indians onsie! (Which I’m guessing was advertising given to the hospital rather than bought by the hospital.)

          • Elizabeth A

            I had my baby too early for a Red Sox onesie (they didn’t have that contract with the BoSox yet). But daycare did carefully teach my children which team to root for.

          • Charybdis

            Or, on the other hand, maybe they need to give out samples from ALL formula brands and varieties: brand name, generic and store brands, soy, hydrolyzed, etc. That way, they can’t POSSIBLY be creating favorable market share for any one product.

            This is ridiculous. It is the fact that formula is FOOD for infants that is upsetting you. All the other freebies (breast pads, manual pumps, nipple cream, diapers, bottles, milk storage bags, wipes, pacifiers, onesies/t-shirts, blankets, etc) apparently are all fine and good to hand out willy-nilly. But the second you put FOOD not from a breast into the mix, then the gift bags need to be banned from a lactivist perspective.

            Breastfeeding is also undermined by the rabid “breastfeed at all costs-it’s easy and it’s free!” mentality shoved onto a new mother. You are forced to do it in the hospital so their EBF numbers look good, but the second they leave the hospital, quite a few will stop breastfeeding immediately because of the browbeating and guilt, some will combo feed and some will continue to EBF. And when these women are asked about their breastfeeding experiences, they are not listened to, much as you are not listening now, nor have you been for the past several days.

            Quite a few of us have given our stories and circumstances in regard to breastfeeding, explained in detail exactly how pumping is *NOT* free if you work and explained, again in detail, how formula feeding can be less expensive than breastfeeding. You aren’t listening. You might be hearing what we are saying, but you are not truly listening.

          • nikkilee

            I hear those stories too, about women being bullied into breastfeeding, and harassed for not doing it. I am but one person, and I promise to do something with all the truths you are all giving to me. It has already changed my teaching, so I am grateful for the comments. My profession has a lot to learn.

          • Who?

            See, you don’t count what you do as bullying because you would characterise it as coming from a place of kindness.

            That may be so.

            But it also comes from a place of ignorance-about how our bodies work, about the practical realities of many people’s lives, about financial constraints, about mental health, about support, and who knows what else.

            You. You have a lot to learn. Heaven knows about the hard science, but also about respecting what other people honestly tell you about their lived experience.

          • Monkey Professor for a Head

            Maybe the place to start is to acknowledge that whilst the are good things about breastfeeding, there are bad things about it too. And when women tell you about their experiences, believe them.

            No one here is anti-breastfeeding. But we acknowledge that it has costs, and that we don’t get to decide for other people which costs are worth it and which aren’t.

          • Amazed

            Yes, just like giving out free chocolate to those who don’t have it undermines healthy eating habits. I should know. I lived in a time and place where we didn’t have almost any chocolate. Not in a single freaking shop. Instead, we had soy sweets. When my father returned from abroad with two huge BAGS of chocolates, it would be a great day for all the kids in the neighbourhood. It didn’t turn us into chocolate whores. It was just a nice prop to have, underlined by the sad lack thereof in our everyday life. I didn’t think of eating chocolate every day.

            You know what undermined my healthy eating habits? When, finally, chocolate appeared in the stores. It was so great to finally have it that I couldn’t stop buying it. Now, I still enjoy it often but it isn’t a need like it was after it miraculously appearing after so many years of only having it when my dad returned.

            What can undermine breastfeeding is the fear that your baby might starve at home like they did in the hospital because you and your ilk only cared about not undermining breastfeeding. I imagine there is a good chunk of women thinking, “Starving my kid again? No way! I’ll top up with formula just in case.”

            Stop being such a hypocrite. Your second sentence says it all: all you care about is breastfeeding being undermined, starving babies be damned. And then, you go into concealing mood again: oh, it isn’t ethical for hospitals not to BUY that formula.

            News to nikkilee: no one here believes for a moment that you care whether formula comes for free, from the market, or from Mars. You just hate it that there IS formula available.

          • Irène Delse

            Indeed. And I’ll add that I find the admonition that “hospitals should market good health care” kinda funny. They don’t have to market it, they provide it!

          • guest

            Yes, I got a six pack of formula nursettes (because BFHI or not, they were adamant that preemies need to be fed, no matter what), two pairs of scissors, a couple of rolls of tape, two thermometers, two packs of newborn diapers, two hats, one pacifier, one baby blanket, two hospital branded t-shirts, two sets of breast pump flanges, bottles, and tubing, some random extra bottles for pumping into, samples of nipple cream (Lansinoh, of course – because advertising), hospital socks, chux, some plastic measuring containers used to heat bottles in hot water, and I don’t even remember what else. It was a lot of different supplies that I got to take home.

            In terms of what was “free,” I can tell you that even when you factor in the reduction in salary that comes with having employer-provided health insurance, my out-of-pocket expenses were still nowhere near the something like $150,000 in combined treatment the three of us got.

          • momofone

            Does the hospital bill for your services?

          • Bombshellrisa

            She probably doesn’t do her cranial therapy, homeopathy or aromatherapy for free either (she does all those things).

          • Roadstergal

            Of course she does… :p Man, I wish I had fewer ethics, so I could make a living off of bullshit.

          • nikkilee

            If you mean are LCs paid by the hospital, the answer is yes, just as are diabetes educators, nurses, housekeeping etc. This becomes part of the general overhead for a hospital and turns into a foundation for billing.

          • momofone

            Maybe there should be a formula consultant too then? To keep things ethical.

          • Irène Delse

            This is an interesting statement, since people are not on the hospital for their pleasure, and while they’re there, they have to eat, drink, get clean, and get the necessary medications. All that stuff is going to be supplied, and it’s cheaper for the hospital to get it in bulk than for everyone to bring in their own food, soap, toilet paper and aspirin. And some of that stuff, yes, is going to be recognisable brands. Often because they’re brands that people already know and trust. The hospital isn’t interested in buying, say, lots of yogurt that nobody likes and that they’ll have to throw away.

          • nikkilee

            I don’t know about that. . .generally, no one goes to the hospital expecting or getting good food.

          • Elizabeth A

            Mores the pity on that one. Hospital food can impair recovery quite badly.

          • Irène Delse

            That’s a good point: offering the customers to try for free and judge for themselves is more ethical, after all, that just making promises about the product through advertisement.

          • Bombshellrisa

            Free stuff: somehow we are getting free things from Seventh Generation. They are deliberately undermining my homemade laundry detergent. Is it brainless of me to buy Seventh Generation laundry detergent because I found out it takes out stains like nothing less, since without that sample I would never have known that? They included a pack of coupons too.

          • momofone

            Well, sure, if you just want to play right into The Man’s hand!

          • Bombshellrisa

            Gullible me, I wanna do the extra work and spend more so I can say I make my own laundry detergent.
            I did the math and between the sale and the coupons, a big bottle of seventh generation detergent will cost $3 and the dish soap will cost 91 cents.

          • KeeperOfTheBooks

            Well, being but a weak-minded woman, you couldn’t help but fall prey to the Evil Corporate Machinations of Seventh Generation. I mean, once those coupons and samples entered your mailbox, you were doomed, DOOMED I SAY, to buy from them! (Which leads to the hilarious mental scenario of what would happen if you also got samples/coupons from Tide, All, Purex, Downy, and Clorox: would you be forced by the Evil Corporate Overlords to buy the 128-ounce extra value size of each of those products every week, too?)

          • momofone

            Huggies did the same thing for me. Are you going after them?

          • Bombshellrisa

            Pampers and Huggies also do those points programs and some of the things you can trade points for are pretty fun.

          • Kelly

            Umm…. I have no clue which brand my hospital gave me. I do know that they gave me Pampers diapers each time because I really like them and continued to buy them. Once, we were past the newborn stage I cloth diaper and buy my diapers from Target. I started with one of the brand name formulas and then once it ran out, I used my leftover Target formula from the last baby, and then I started using Sam’s Club because it is the cheapest for me. I made my decisions on formula before my baby was born. There are some people who are brand concious but most people aren’t, which is why off brand formulas are still around.

          • Irène Delse

            I don’t get this obsession with “OMG free formula samples will undermine women’s will to breastfeed”!
            Yes, companies want people to be aware of their brands and try their products, because they compete with other brands for market shares. But even if I try stuff that’s given for free doesn’t mean I’ll buy it for months on! Like for instance, my pharmacist gave me some samples of toothpaste. I tried it, but I’m not going to switch brands, I like my usual brand better.

          • An Actual Attorney

            My dentist always gives me a toothbrush and sample size toothpaste and floss. I still don’t floss.

          • Who?

            You really should. Your teeth are your best friends. Takes 2 minutes. The little tear of happiness in your dentist’s eye when you go for your next appt, along with your enhanced gum health, will be your reward.

            And it does feel kind of good when it’s done.

          • An Actual Attorney

            I know I SHOULD, I just don’t.

          • The Bofa on the Sofa

            As Who? suggests, one of the biggest benefits of flossing is that the dentist loves you. When I am flossing, I don’t dred the dentist at all, because I know they aren’t going to make me feel guilty about anything. I could have 10 cavities, but because I floss, the dentist loves me.

          • An Actual Attorney

            Yes, but I derive my self-worth from doing exactly the opposite of what the educated medical professional recommends. That’s how you know I’m not a sheeple, I’m an educated mama. Do your research.

          • Who?

            😉

            But try the flossing-for funsies.

          • guest

            I never used to. Then I had a dentist tell me that, really, if you can do it every other day it’s just as good. This may have been a lie, but it worked to get me started flossing, just every other day. And eventually every day.

            I still allow myself about 5 cheat days a year, because I still hate flossing.

          • An Actual Attorney

            OK, OK. Sheesh. You all can get on me next about exercise.

          • Eater of Worlds

            My teeth are incredibly clean. So much that it takes them about 3 minutes to scrape the tiny bit of tartar off my teeth and the dentist was asking me what I did to keep my teeth that clean. And yet, they are rotting out of my head. Age has done that.

          • Roadstergal

            Have you considered worlds that are lower in sugar?

          • Eater of Worlds

            Yeah, but I didn’t have a single cavity until I hit 40. My teeth are very tight together and even the dentist struggles to get floss between them.

          • guest

            i don’t know about Eater of Worlds, but you can pry my sugar from my cold, dead hands.

          • Who?

            Age, the shape of your teeth, the state of the enamel.

            I have two kids, one no fillings, one a mouthful. And she will likely need at least one crown before she’s 25. Teeth are individuals, just like people.

          • Squillo

            IIRC, there has been some recent research that suggests that flossing isn’t that important. (I have no idea how reliable it is.) Of course, I love to floss and have amazingly healthy teeth. N=1.

          • nikkilee
          • Heidi

            I’ve read that first article over and over and I can’t find the actual percentage of women who received samples that quit breastfeeding versus those who received none ANYWHERE. Am I missing something? Are they leaving it out because it’s fairly underwhelming?

            The CDC thing says 7 of 11 studies found a correlation which means, I guess, that 4 didn’t.

          • swbarnes2

            This is the Pubmed entry for the article reference in the first link, but I can’t read the journal. It’s awfully confusing, in part because the “intervention” of not giving formula wasn’t followed very well. The key sentence in the abstract is this:

            http://www.ncbi.nlm.nih.gov/pubmed/22638306

            “In post hoc analysis, receiving no take-home formula in bottles from the hospital was associated with increased exclusive breastfeeding in control (P = .02) and intervention (P = .03) groups at 10 weeks.”

            But without the greater context, I’m not sure what this means. Maybe the exclusively breastfeeding mothers didn’t remember getting formula, or left it behind, and said they didn’t get it? Maybe the mothers who wanted formula were asking for it, so of course they got it and then went on to use it?

            And how much of an increase? This study is small, so you couldn’t reliably detect a 2% increase, but maybe it causes just a 10% increase?

            And what if 70% of the mothers who got formula gave their kids formula once a week, or twice a month, as a respite, and breastfed the rest of the time. Is that really so hideous? Why is that a situation that needs to be avoided at the cost of denying mothers safe food for their babies?

            We know that there are lots of women who supplement in the first week or so, and then go on to breastfeed for a long time. Those women would not be counted here as success cases, and that’s stupid.

          • Charybdis

            This is a bad thing how, exactly? No one is saying one brand of formula is better than another, nor is anyone saying the generics and store brands are inferior to the brand name formulas. The companies that make formula are competing for market share for their product. I’m fairly sure (correct me if I’m wrong) that the specialty formulas (Elecare, Neosure, Nutramigen and Alimentum, etc) don’t have generic equivalents, so one is stuck paying full price for it or is dependent on manufacturer’s coupons, discounts, samples, rebates, etc for any savings.

            The formula contained in the lovely diaper bags they gift away are *not* full size containers of product, they are samples. I got one from both Similac and Enfamil when I left the hospital. Guess which formula DS wound up on? Good Start was the brand he did the best on. I had gotten a sample of it from my pediatrician.

            Again, we are back to the food element of the gift bags being the lactivist’s main issue with them. The changing pad, coupons for diapers, wipe samples and couple of diapers inside the bag were lovely. Apparently Medela provides bags with breast pads, nipple ointment, a manual breast pump, etc in THEIR bags and these are just fine to hand out, according to the lactivists, because there is no food in them. It “encourages and supports” breastfeeding.

            Why are they so damn determined that some babies not be fed sufficiently? A formula sample is no more a slippery slope than a free manual breast pump and milk storage bags.

          • Elizabeth A

            Economically, the claim that the formula industry gains $700+/year when parents buy the name brand used in the hospital doesn’t really make sense.

            The name brands used in the hospital vary from hospital to hospital. Some parents will look at the prices and eschew name brand formula, but many are not price sensitive about this – they buy what they’re familiar with, or what they see ads for, or what they remember a friend using – all name brands. Industry profits don’t increase because the name brand is Enfamil instead of Similac or vice versa. If they did, those profits would average out nationwide, and probably remain flat.

            I’ll note that parents who choose breastfeeding aren’t terribly price sensitive about their feeding choices either. They choose to take the hit of the cost of the mother’s time (which can be quite high – I’ve given my $130/week example in this thead already).

            Families who are price sensitive wind up on store brand formula, which is just as good and a whole lot cheaper, but which many families are discouraged from using by factors that sometimes include criticism from LCs about the bargain choice.

          • nikkilee

            I am still curious how pumping could cost so much. Women aren’t paid to pump; they are to use their break and meal times. The $700 figure comes from the literature on the topic. Some hospitals have gone to Sam’s Club or Costco to purchase generic formula, because it is nutritionally equivalent and way cheaper.

          • Monkey Professor for a Head

            Did you not read her reply? She had 5 hours of unpaid pumping that she could have spent working and earning. Do you think she’s lying? Why are you dismissing her experience?

            You say you will support a woman’s feeding choices, but you minimise people’s experiences when it doesn’t fit with your ideal reality. That is not support. In fact it’s skirting close to gaslighting.

          • An Actual Attorney

            Not all women are paid hourly. I bill out at $700/hour. Like most lawyers, I bill in tenths of an hour. If I spend 6 minutes mucking about putting milk in a fridge, washing parts, redressing, that’s $70 I don’t bring in. And, because of the way we bill, if I spend 7 minutes, that’s $140 foregone.

          • Who?

            Literally liquid gold.

          • guest

            I don’t get breaks, Nikkilee. I am salaried. I have an amount of work that I am expected to complete, and then on top of that I’m expected to exceed that amount in order to advance in my career. I can’t put an exact number on lost wages from pumping at work, but it would have made it difficult to complete the amount of work I needed to complete in a reasonable amount of time. If I stay late to finish it, that costs extra in childcare (more than the cost of a can of formula by far).

            On top of that, if I have to walk through my office carrying used pump parts for washing, or make a colleague wait to talk to me because he or she comes at an inconvenient pumping time, I risk losing status in the office. It should not be this way, but it is. I risk being seen as unprofessional, disgusting, or uncommitted to my career, and all of those things can potentially hold me back from advancing, which means lost future wages.

            I don’t want it to be this way, but it is this way, and pumping at work was not for me.

          • nikkilee

            Awful, and I get it about why you couldn’t do it. It’s too hard to fight uphill all the time.

          • Elizabeth A

            This is, in many of our opinions, a much bigger barrier to breast feeding than formula marketing, or anything that happens at the newborn stage, but it often doesn’t even show up as a possibility on multiple choice surveys. I winds up stuck under “lack of community support.” (No, my community did not support breast feeding. I had less than 3 months of protected parental leave. Workers for my current employer get 8, because they’re too small for fmla.)

            It’s as though, since we have a right to those pumping breaks, LCs have decided pumping at work can’t possibly be a problem, and gone back to signs on the subway, slogans on the cans, and making sure no one gets a free diaper bag.

          • guest

            Do diapers bags coerce women into formula feeding too now? I guess breastfed babies don’t shit.

          • guest

            So why are your trying to guilt women into doing it anyway? Focus on securing paid maternity leave and better wages for all workers.

            Because the thing is, while I didn’t find pumping at work practical, my job gave me 8 months of paid leave (not all maternity leave, but still 8 months off at full pay), and that is not the norm. I shouldn’t feel guilty for not doing enough – I should feel privileged to have had more support than most American women.

          • nikkilee

            How will society change without hard work?

          • guest

            Shaming women is not “hard work.” Asking women to sacrifice themselves and their families for your ideal isn’t “change.” It’s oppression.

          • demodocus

            Who said the change was for the better?
            Personally, I love it when people assert things about history, societies, and other cultures when they didn’t study any beyond high school. A minor version of what mds and scientists face. *eyeroll* Oooh, 7 babies survived Dachau? Another question is how long had their mothers been there? The deportations didn’t cease in 1943.

          • Squillo

            Amen. And it isn’t always about lack of support or time. I had all the things that are supposed to make pumping work: An office with a door, a salaried position and discretion over my schedule, enough income to buy a hospital-grade pump and all the storage items, a suitable place to wash pump parts and store milk, and supportive co-workers.

            I couldn’t pump enough to feed my son through his 8 hours of daycare. The 8 oz. or so I was able to pump through multiple sessions just wasn’t worth the effort and loss of productivity. So he got formula at daycare and breastmilk at night.

            Pumping was fine by the time my daughter came along; I wasn’t working and could pump enough over several days to have a slight cushion of stored milk if I wanted to be away from her for a few hours. So she never got formula. All it cost was the six figure income I gave up to be a stay-at-home mom.

          • guest

            Yes, I had colleagues who tried to be supportive, a chair who was willing to schedule my classes so that they worked with my childcare (though it helps that morning classes are better for that, and not many people want morning classes), and my own office with a door. I wouldn’t call our shared kitchen suitable for washing pump parts since no one ever cleans it, but all in all, support was there. It just still doesn’t work sometimes.

          • CSN0116

            Most women need to pump 2-3 times per 8 hour shift. Each session is 20-30 minutes to get to the pump room, setup, pump, store, cleanup, and get back to the workplace. I don’t know where you come from, but most employees get one 1/2 hour lunch break; sometimes this is unpaid and their work day is elongated to 8.5 hours long.

            A $10/hour worker stands to lose $10-$30 per day doing this, as that time will have to be made up. The law does NOT require the pump session time be paid time – haha, no. And we’ve already been over the fact that even built-in breaks are not necessarily paid. If she works five days per week, that’s $50-150 per week in lost wages; $200-600 per month. And when her workday is extended, it’s likely her childcare expenses are as well. Tack on collection bags, bottles, coolers, additional pump parts, etc.

            Fuck that noise. My baby formula feeds for $40 per month, no hassle, and the same fucking outcome.

          • nikkilee

            How is a month of formula only $40?

          • CSN0116

            I have EFF five children.

            I use Target’s Up and Up brand, extra large tubs, 5% Red Card Discount, $10 off when I buy 3 at once, Cart Wheel App, and (sometimes) coupons in addition to.

            $40 is the max per month. I spend less the first month and last two months when intake is lower.

            I EFF for ~$500 per year.

          • Who?

            So far I’m at 100% accurate prediction of crickets from nikkilee-she won’t engage with stories that don’t match her narrative.

            I foresee crickets here.

          • CSN0116

            Pssssh. A large 1020 gram container makes 232 reconstituted ounces of liquid formula. My babies take 24 ounces per day (four, 6 ounce feedings), so that’s 10 days worth of feeding for $23.99 full retail price.

            I don’t pay retail. (Though even retail would only be $72 per month.)

            I pay ~$15 per container after all the Target discounts. You can’t fight facts. And I swear I’m going to write a book teaching people how to do this 😛 A lot of people don’t qualify for WIC but struggle. I just grew up crazy poor and ‘came up’ but can’t detach from my roots, so I’m cheap as fuck.

            And I hear that Sam’s Club is even cheaper per reconstituted ounce, and they give bigger bulk discounts. I’m missing out! But I don’t have one near me 🙁

          • Who?

            I’m sure that’s right-my point was you won’t hear from nikkilee-she only engages with details she can ‘rebut’ with her nonsense.

          • CSN0116

            Well I’d love to entertain her, and teach her some things too! 😉

          • Who?

            While I have no doubt whatsoever as to your skill as both an entertainer and educator, I doubt nikkilee is open to being entertained or educated on this topic.

            And, as predicted, she hasn’t responded to you. Despite making time to note above that breastfeeding does not cost mother any calories, so breastfeeding women don’t need to eat more than they usually would.

          • CSN0116

            Doesn’t every source say contrary? Even weight loss apps have you identify as a nursing mother so they can alter your caloric requirements (increase).

            Ahhh but that would hurt the “breastfeeding costs nothing” thesis. Extra calories are needed, and they cost extra money to purchase, and they put additional strain on the environment to produce.

            She’s probably cut from the same cloth that says all breast milk has the same caloric and fatty content, and just because mom ate a piece of toast and a handful of almonds all day, and her milk is so watery you can shine light through it – well it’s irrelevant and that milk is nutritious 😉

          • momofone

            That’s impossible. Formula feeding is horrendously expensive and incredibly hard! Right, Nikkilee?

          • Bombshellrisa

            We were very poor until I was 12–I learned from that too and in a good way. I think it can make you more resourceful. I always look at the ads, clip coupons (our local library gives away free Sunday papers, so my coupons are free and I get all the ads that way) and comparison shop. We check Slickdeals a couple times a day. I am part of my local Buy Nothing chapter. Toys, kids clothes, baby gear and even formula are offered up for free. We also do the Target cartwheel app and buy so we can get the gift cards and roll them onto our next purchase. The savings add up.

          • demodocus

            generics, discounts, couponing, and sales. Combine them and you can get a wedding dress for $35. (granted, it was 2nd hand, but I wasn’t complaining. It was almost perfect anyway and it 1 day to make the adjustments.)

          • nikkilee

            I had no idea. My profession has no idea. Thanks.

          • demodocus

            Well, you did ask. Maybe your area’s sales and generics are more expensive, but considering the number here who’ve gotten formula that cheaply in the US, it’s not a uniform thing.

          • Who?

            Obviously had never, in all her forty what years of doing this, thought to ask about the cost of formula, in between preaching how expensive it is.

          • Elizabeth A

            Nikkilee, perhaps your profession should make a habit of looking into these things because you hold yourself out, professionally, as an expert but appear staggeringly clueless about a startling number of basic issues.

          • fiftyfifty1

            “I had no idea. My profession has no idea. Thanks.”

            I think this pretty much says it all.

          • D/

            I have an idea … If you’re educating folks on costs of infant feeding, that information should be common knowledge.

            I taught the breastfeeding classes at my hospital for about 19 years. I knew exactly how much an average year of infant feeding straight off the shelf was locally because at least every other year I would price formula at Target, Walmart, and Kroger— the three major formula brands plus store brands for each, as ready-to-feed/ concentrate/ powder, including both standard cow’s milk based and specialty formulations (Alimentum/ Nutramigen)— and breast pumps at local vendors and rental stations.

            Stuck it all on a chart and mentioned couponing/ bulk purchases/ etc for potential additional savings. IIRC there was over $1200 per year cost difference between Walmart/ Target standard store brand powdered formula and grocery store name brand standard ready-to-feed formula … I let the prices speak for themselves. Did the same with breastpump purchases vs short-term or long-term rental.

            I haven’t taught a breastfeeding class (or paid much attention to formula prices) in 4 or 5 years, but for fun I glanced at store brand powder as I was running through my local Walmart tonight.

            Here’s an example of a food cost comparison of the most expensive pumping option and least expensive formula option at current local-to-me prices: If you wanted/ needed to rent a hospital grade breast pump long-term from me for a year, I’d be ethically bound 😉 to charge you ~$65 less/ year than a year of Parent’s Choice 35 oz powdered formula tubs would run you . Then add the $(500+calorie) extras *many* breastfeeding mothers find themselves needing to include in their own grocery bills.

            Breastfeeding (and/ or pumping, especially if your insurance provides a pump that works well for you) *may* save money, but *only* if it goes well, you make plenty of milk, and it doesn’t compete with the ability to earn needed income. Anyone having to purchase a decent retail pump for back to work and spending even $5.00 per week on extra groceries is going to spend **at least** as much as those Target formula super deals that Heidi and CSN0116 have down to a science!

          • The Bofa on the Sofa

            Why not?

            Seriously, I mean it. Why doesn’t your “profession” know this?

            Think about that for a while. Then maybe you will understand why we have such little respect for people like you.

          • Charybdis

            Probably because they *don’t* want to know, because it calls their worldview into question.

            Breastfeeding = always free, always easy, pumping allowed everywhere, something, bonding, something, most natural, healthier, beautiful, insufficient supply is so rare that it really doesn’t need to be mentioned, ever, yadda, yadda, yadda.

            Formula feeding = prohibitively expensive, mixing errors, formula can be contaminated, time consuming (boiling water! sterilizing bottles!), toxic sludge, results in fat, unhealthy babies that will grow up to be a burden on society, force feeding baby, nipple confusion, something, coercion by hospitals, conspiracy with formula manufacturers and hospitals, blah, blah, blah.

            If they actually LISTENED to women’s experiences, then they would see that there are pros AND cons on both sides and that women will do what works best for their individual circumstances and that EBF isn’t the bee’s knees, wasp’s nipples, or any other erogenous zone on an insect. Then their entire self-image and self-worth is called into question. Can’t have that.

          • Irène Delse

            I was thinking that there is a lot of woo in adult nutrition, but at least professional dieticians take an evidence-based approach and that you can usually trust what they have to say.

          • fiftyfifty1

            “Then their entire self-image and self-worth is called into question. Can’t have that.”

            Well that and $$$. In nikkilee’s case, it’s much more than just her ego, it’s her livelihood.

          • Charybdis

            How is breastfeeding *always* free?

          • Heidi

            So I was looking at my Target order history. On average, I order 3 tubs of 40oz. of Up & Up formula every seven weeks. It’s $24 a tub. (Even if you live in a state with higher prices, it’s all the same online.) But since I get three at a time, I get a $10 Target gift card every time, which I usually apply to the next formula order. So it starts out at $72, but with my giftcard it’s down to $62. Since I have a Redcard, I get a 5% discount on the remaining $62 which brings it down to $58.90. It ships totally free. This lasts 56 days. That means daily formula costs me $1.05, which for 30 days costs $31.55. Now most days I can manage with a lot of time and effort to squeeze out 8 oz of breast milk a day so that might be around a quarter of my baby’s daily intake. If I didn’t breastfeed, that would bring it up to $39.44. However, I could be more judicious with my formula use. I have a Baby Brezza that makes the bottles in 2 oz. increments. If he is only going to take 3 oz., I could put the fourth ounce in the fridge, but most the time I don’t. I could be paying even less for formula. On the average day, I’d guess I throw 4 or 5 ounces out.

          • CSN0116

            I get giggly happy just thinking about it 😀 Well done!

          • nikkilee

            Thank you.

          • momofone

            Did you not read her answer? She lost work time in order to pump. This is the intersection of how things work in theory and how they work in reality.

          • Who?

            ‘Break and meal time’: so women who have the statutory entitlement to a break don’t get one, because they are pumping (and depending on how much they are pumping, may end up with not enough break time to pump); and professional women who aren’t entitled to a break, and for many of whom time is money, neglect their professional responsibilities to pump.

            Way to have a productive work day.

          • Elizabeth A

            I did answer that question, and so did you, right here. “Women are not paid to pump.” I was working hourly at the time, and my work time was constrained by daycare hours, so 20 minutes spent pumping was not replaceable. I couldn’t arrive early or stay late to get more billable time in.

            Five hours a week of lost income cost me $130 at my then current wage.

          • Heidi

            In the real world, breaks don’t always happen. I worked as a tech in the ER. It was way too hectic to get 2 paid 15 minute breaks. If I did take my breaks, I’d be putting my work onto a co-worker. That co-worker sure wasn’t getting compensated for taking on my duties or my patients. I got a 30 minute lunch break which involved either getting my food from the cafeteria or warming it up. How is one to fit in a 30 minute pumping session? I’m pretty sure it wasn’t illegal either because of the nature of hospitals. And when on the rare occasion that ER wasn’t packed to the gills, and I got a rest, I really wanted to take a breather, not attach myself to a pump if I had been lactating at the time. I also used to work as a paralegal where every single minute I was at work had to be billed to the client or the law firm. Even the time I spent in the bathroom had to be billed to someone so my 15 minute breaks were considered the time I’d get up to go potty, make a coffee, etc.

          • BeatriceC

            I was a teacher. My contracted time was from 7:45 to 3:55. Classes were from 8:15 to 3:30. I generally got to school around 7:15 in order to get ready for the day since I had some sort of duty (meeting or drop off duty) from he start of my contract time to the first bell. Once my students were in the classroom I had to be there. I had 5 minutes between classes in which I was expected to stand at my door and supervise students as they left my classroom and the new ones came in. I had a 25 minute planning period twice a week, and that was usually taken up by meetings. On the rare occasion I didn’t have a meeting, I did silly things like plan lessons, grade papers or make copies (rare, since I could only make 300 copies per year and had to go to a copy store and pay out of my own pocket for the rest). I didn’t even have a duty free lunch. I was expected, along with my colleagues, to eat lunch while supervising the students. After the last bell I was expected to supervise dismissal until the last minute of contract time. I rarely had time to even pee. Pumping was impossible. I did pump after dismissal and before I started all the rest of the stuff I needed to do, but that just delayed my arrival home, and I wasn’t getting laid for that time anyway. Thankfully I was blessed with a massive oversupply and my body got used to the schedule. If I was normal as far as supply goes it would have been impossible.

          • demodocus

            You mean you *didn’t* want to help “normalize” breastfeeding in front of 25-35 students. For shame!

          • Amazed

            Well, the lady who did that was a professor, IIRC. Your average teacher isn’t that enlightened.

            Don’t worry, Beatrice. We know it wasn’t your fault. We still like you, right, Demo? RIGHT?

          • demodocus

            Um, yup, what you said 😉

          • BeatriceC

            Closer to 40-45 (And one notable year, 52 in one class), but no. I don’t think so. 7th graders. Do I need to say more?

          • demodocus

            Ah, my urban student teaching experience was at a school with an average of 30 kids. (I don’t know how long they’ve been calling it urban but it’s the same low SES city communities)

          • BeatriceC

            Some schools are really overcrowded. Mine got better when the state put in a class size law, but not great because they could count aides as part of the ratio. A friend of mine who used to teach in a Las Vegas high school had classes over 60 students.

          • demodocus

            icky

          • Bombshellrisa

            If you worked in the ER, I will bet that there were shifts where you never even got to use the bathroom because you were so busy. I have worked double shifts on a med/surg unit where I only got to go to the bathroom twice. You would think Nikkilee would know that because she was a nurse at one time, but she is the typical tune people out lactivist.

          • Heidi

            I worked on Med/Surg before ER, and yep, it was a super busy nightmare, too, especially if you had a night with a code or two or even three thrown in and then ER decided to send up all the patients instead of diverting them to other ERs despite the fact there wasn’t enough staff to cover the current patients. Yeah, try pumping when you are a nurse with 10 high needs patients or a tech with 15 of them.

          • Bombshellrisa

            The two (or more) code night! Even if it’s not your patient, the entire floor is affected. Or if there are multiple 3am admits from ER (our medical side closed down at 3:30am for four hours, so they are always making room by admitting people). Or if a patients needs a one to one and a tech or nursing assistant has to be pulled from the floor to do that and everyone else has to scramble to rearrange the patient load. Running a blood transfusion or drawing blood cultures is also another way to run far behind. I can’t imagine trying to pump with those circumstances.

          • Heidi

            In my working years, I’ve worked as a paralegal, a med/surg tech, an ER tech, and then with a place that served those with severe mental disabilities. The latter was the least stressful. But I couldn’t have even pumped then. The person I worked with had to have someone one on one with her at all times. We had to be within 8 feet of her at all times. It was illegal for whoever was responsible for her to be responsible for anyone else. There were other patients that lived in the same house who had similar restrictions. Again, no way pumping was happening for any employee who worked there.

          • nikkilee

            Nope. I know what it is like to run around for a shift and never have time to eat or pee; this is what makes pumping at work virtually impossible for healthcare professionals. . . .unless hospitals hired enough staff, which they don’t.

          • Who?

            Well that bit of sleep has changed your tune-trying to rehabilitate yourself?

            Next you’ll be running around deleting your more foolish remarks.

          • Bombshellrisa

            Then act like you understand it! Hospitals should staff better, but the reality is that having many duties and multiple people who need you as part of your job will reduce the likelihood that you will get large amounts of time to leave those duties and people to pump.

          • D/

            ^Yes.

            I am currently employed at a hospital with an HR policy providing lactating mothers reasonable PAID break times throughout the day for pumping. The policy for non-lactating employees, however, is ‘breaks are scheduled as the workload allows.’

            I suppose the moral imperative of sacrificial pumping, especially as a lactation consultant with such “generous” workplace accommodations, would require me to somehow alter the reality of my daily workload … many shifts extend hours past what I am scheduled, my workload allows a now-drive-yourself-home break when the day’s done, most (normally unpaid) meal breaks are paid because multi-tasking a simultaneous lunch while charting or returning phone calls allows the day to end 30 minutes sooner, and *every* day requires me to triage out *many* mothers and babies who need/ want my help.

            While technically my employer would pay me to pump (if I had breasts at this point capable of producing anything other than perhaps a puff or two of dust, that is), my need to introduce combo formula feeds after returning to work (just as I did over 25 years ago) would not have been eliminated by an unrealistic pretense of generous pumping accommodations … **in the real world**.

          • Azuran

            I’m one of the lucky few with fixed salary. I have a yearly salary divided weekly. In exchange I have a work to do, I do it as fast or as slow as I want and when I’m done, I can leave no matter what time it is. So technically, pumping wouldn’t cost me any salary.
            However, putting aside the fact that if I take pumping breaks like that during the day I am dumping a massive amount of work on my coworker to compensate for my breaks. And that I’m probably causing everyone else to have to stay later because I’m slowing down the whole hospital.

            Logically, if I take 1h of break through the day to pump, then that’s 1 more hour of my time I’ll have to spend at the job. That’s 1 less hour I get to spend with my baby and my family. That’s possibly 1 more hour of daycare I have to pay, 1 hour I’m not spending doing chores around the house or making dinner. So in term of salary, maybe it doesn’t cost me, but that’s still 1 hour of time I’m losing, and my time isn’t worthless.

            But luckily for me, I live somewhere where mothers are valued and I get 1 year of paid maternity leave.
            Pumping at work isn’t even something that happens where I live.

          • corblimeybot

            You’re an incredibly privileged person if you can’t even guess why pumping is expensive. You live in a world of security I can only dream of.

            I don’t get breaks or meals, even if I work 13 hour days. Should I be legally entitled to them? Probably, but that’s a fantasy world.

            I work in an office that requires exactly two employees on duty at once. Company policy, no exceptions. No more, no less.The only way I could have pumped at work, would have been to:

            -clock out of work entirely
            -have someone come into work to cover for me for 45 minute to an hour
            -pump
            -go back to work and clock in
            -kick out the person who came in to cover for me.

            Realistically, that would never happen. If I tried to take a pump break and someone had to come in to cover for me, my boss would have just sent me home every time. Half a days wages lost for the entire time I’m pumping. Does that sound like pumping is free or cheap?

            Also, thanks for your unquestioned belief that women should give up their meal breaks to pump. I haven’t had a real work lunch break in my entire life. I guess you’ve had plenty of real lunch breaks, from your obvlious tone.

          • nikkilee

            I pumped for a year for a friend; it cost me $300 to rent a pump for a year, but that was a friendly discount.

          • Monkey Professor for a Head

            Why bother replying to her post without actually addressing anything she said. Just because you have pumped doesn’t mean that other women’s experiences were the same.

          • corblimeybot

            Thanks for confirming to me that you are, in fact, insanely privileged.

          • nikkilee

            Pumping at work is expensive in terms of time, and I never did think of it be costly in money. Many healthcare professionals, physicians included, want to breastfeed and start. And they can’t sustain, because who can leave surgery in the middle, or leave the floor leaving another overworked nurse to cover all one’s patients. From my perspective, we have fought so hard to get the laws to change that we (breastfeeding workers) feel excited about that. But still, it seems that in the long run, the working mother is suffering just as much as ever. I am humbled. Thank you for sharing your story.

          • CSN0116

            No. Women are suffering more than ever because there is no acceptable reason NOT to perform at this level. No logical excuse exists and the need for better maternity leave has been eroded. The technology (pumps) and policies have been taken care of …never mind the mental, emotional and physical strain.

            You have all done women a huge disservice with this moral pet project you just had to conquer.

          • Who?

            You worked so hard-right through your lunch break, probably, for which you were paid-so other women would have the right to do what you thought it was important that they do.

            Very noble of you.

          • Charybdis

            Time consuming, yes, as is breastfeeding itself. How can you claim to know that pumping/breastfeeding is expensive in terms of time but deny making the connection that it is expensive in terms of money?

            And that formula feeding is not the major, prohibitive expense that you seem to think it is? Plenty of people here have provided you with their circumstances, either with the cost of pumping itself and the lack of time and facilities to pump, as well as how the cost of formula feeding can be reduced to $50 or less a month. Yet you still argue the point with the typical lactivist zeal; we don’t know what we are talking about, provide outdated studies show incorrect/inconclusive results and generally ignore what you don’t like to hear because it challenges your version of the “truth”.

          • Heidi

            How much do you think the average woman spends on extra food to make breast milk? I was told to eat an extra 500 calories at least. So that’s about an extra meal every day. It’s not that crazy to spend $2 on a meal, and that’s not a super expensive one. I mean, ideally you want to eat foods that are high in vitamins and minerals. You could eat your extra calories with almost nutritionally empty food that is really cheap, but then you’d start bankrupting your own body.

          • nikkilee

            Don’t need extra food to make breastmilk. Cows and dairy goats need extra food, but not humans.

          • Monkey Professor for a Head

            Then why the hell have I been starving for the past 11 months?

            Where do the calories in breastmilk come from if not from the mothers body? You’re just making stuff up now?

          • Amy Tuteur, MD

            Are you joking?

          • nikkilee

            Copying a post from above. . .this thread is long..

            Your metabolism is at one end of the spectrum. I’ve had clients that couldn’t gain weight no matter what. (Now I would send them to have their thyroids checked out. . . just to see if that would make a difference. Then, I didn’t know about the important role of the thyroid in human milk making and moving.) The other end is exemplified in the 7 healthy thriving babies that were discovered when the Allies liberated Dachau. All the moms breastfed, 2 moms breastfed another baby besides their own. All the babies grew up, married and had their own children. During the WWII siege of Leningrad, when people were eating bread made of sawdust, some women had so much milk that a milk bank was started to feed the babies whose mothers had died. Humans have a wide range of variability.

          • Who?

            Still irrelevant no matter how often you copy and paste it.

          • Roadstergal

            Mommies break the laws of thermodynamics!

          • Monkey Professor for a Head

            Breastmilk is so magical that it can be created out of nothingness!

          • KeeperOfTheBooks

            That’s “mamas,” I believe. 😉

          • Azuran

            That is an absolutely ridiculous statement. It’s the first rule of thermodynamics lady. You cannot create breastmilk out of nothing. If you don’t eat extra food you will lose a dangerous amount of weight.

          • BeatriceC

            And this is where you show that you clearly have absolutely no idea what you’re talking about. This is middle school science level stuff you’re trying to deny.

          • Azuran

            Really, I’m curious. What is your logic for saying that women don’t need to eat more but that other animals need to?

          • nikkilee

            I don’t know; some think that domestication for millenia play a role. We certainly make cows produce way more milk than they would for one calf; that is calorically costly.

          • Elizabeth A

            But you argue above that a few overproducing women could feed unknown numbers of babies without extra calories during the siege of Leningrad.

            Your math doesn’t work at all. Logically, if producing 10x the milk that an organism’s actual offspring needs has a caloric cost, producing exactly the amount of milk an organism’s actual offspring needs should have 1/10th the caloric cost. If the caloric cost to feed one child is 0, the caloric cost to feed ten should also be 0. If the caloric cost to feed 10 is 100, the cost to feed one is 10. AND SO ON.

          • Who?

            Oh I think I can predict nikkilee’s response to this entirely logical application of her entirely ridiculous assertion.

            Crickets.

          • Elizabeth A

            I might have preferred crickets.

            Hold my earrings. I’m going in.

          • Who?

            😉

          • nikkilee

            The Leningrad story came from a colleague who toured in Leningrad, whose tour guide was a baby saved by that milk bank. An example is NOT an argument. Of course women shouldn’t starve; women should eat and drink. But the actual caloric costs of human lactation are less than the 500 calorie number that has been floating around for years, cited over and over again in different studies.

          • Amazed

            And my uncle was a baby who was fed cow milk, goat milk, bread soaked in wine and whatever came their way during WWII because my grandmother’s milk dried up at day 40. He was the very picture of thriving health all the way through my childhood. Magical breastmilk didn’t do anything for him because it wasn’t there. But he survived. That’s the only thing that matters. He survived on whatever they had. Since you’re so big on anecdotes, won’t you take this one as a proof that if feeding a baby with anything that could keep him alive without being choosy because you couldn’t afford it worked so gloriously, then surely human-infant-adjusted, strictly regulated formula would yield even more glorious results?

          • nikkilee

            A story is an example, and not meant to be recommended practice. I have a similar family story; the great-uncle in question lived into his 90s. And, as you say, this is not recommended practice. And yes, formula is better than this. And yes, babies do best of all on breastmilk.

          • Monkey Professor for a Head

            You stated that breastmilk contains 16-50 calories an ounce. The average baby needs roughly 25-35 oz a day. So that would equate to 400 calories a day at very least, probably more. Plus it takes calories to actually manufacture the milk. So I’d be very surprised to find that the lactation actually commonly costs less than 500 calories a day. These calories have to come from somewhere. There are three options that I can think of. The mother can eat more – and food costs money. The mother can use her fat stores – not everyone has excess fat stores to use. Or the mother can lower the metabolism in the rest of her body to compensate – which is going to have effects on her health and wellbeing.

            It is completely disingenuous to pretend that breastfeeding is without any sort of cost. I think you are so fixated on breast feeding being a good thing that you can’t accept anyone saying anything in anyway negative about it. Breastfeeding does not need to be perfect in order for it to be a good thing for many women. And the fact that it is a good thing for many women does not mean that it has to be a good thing for all women.

          • nikkilee

            A woman’s metabolism does change when she is lactating. Some women burn themselves up to make milk; they’ve told their stories on this forum. Other women adapt without making major adjustments to diet. And some actually can’t loose weight when lactating. Humans have a wide range of responses.

            I never said that breastfeeding was without cost. We are discussing the costs, and disagree, respectfully.

          • Monkey Professor for a Head

            Women on this board have told you the costs involved for them (both financial and otherwise) of breastfeeding and formula feeding, and you have questioned them and told them that you find it hard to believe their stories.

          • An Actual Attorney

            You are just spitting out words. You have finally agreed that the calories come from somewhere, the food she eats. It doesn’t magically appear because the gods love tits so much they made them a special exception to the basic laws of physics.

            So why did you claim that wasn’t true?

          • nikkilee

            I didn’t, I questioned the 500 calorie figure.

          • Who?

            Rinse and repeat:

            nikkilee
            4(ish) hours ago

            Don’t need extra food to make breastmilk. Cows and dairy goats need extra food, but not humans.

          • An Actual Attorney

            You do know that we can read the words that you type.

            You stated that women don’t need to eat extra food to make breast milk. Remember that?

            Do you think that there’s another magical source of energy in boobs? Yes, there are some women, myself included, who have stores of energy in fat cells, but that only gets you so far. So women have to eat more food, and they have to pay for it.

            Or does manna fall from heaven for the women who pay you?

          • Elizabeth A

            So you now admit that there is an actual caloric cost. Scientists all have it wrong, though. Do you have an estimate about what it is? Perhaps it also varies, based on the volume of production and the caloric content of the individual woman’s breastmilk.

            And maybe those numbers, just maybe, indicate that the laws of physics are not magically suspended for human (but interestingly only human) breastmilk.

            Personally, I think that anyone committed to helping women breastfeed should be starting with basic questions like “Can I get you something tastier than the hospital’s tuna salad?” But you’ve been pretty keen on disregarding things I say, Nikkilee. You ignored my statements about the monetary cost of breastfeeding. You’re busily discounting my report that I was hungry and lost weight while breastfeeding – you acknowledge that it happened, which is an improvement, but you move right along to saying that it’s very strange even though a little math about calories makes it appear very logical.

            You prefer the story you heard from a colleague who heard it from a tour guide.

            I am driven – as I often am – to wonder whether better food on the post-partum floor might have a greater impact on breast feeding rates than lactation consultants. If all LCs are as interested in disregarding what’s in front of them as you are, I think it would be wise to replace the lot with a varied menu of high-quality takeout. Banh Mi and lime soda certainly did more to help me breastfeed than any LC ever has.

          • KeeperOfTheBooks

            A tour guide who, with no offense whatsoever meant to the tour guide, I wouldn’t believe any more than I’d believe a North Korean tour guide who wanted to tell me all about how every North Korean has had and will always have plenty to eat at all times, and any information to the contrary is just evil capitalist propaganda. People in dreadful regimes who get roped into those sorts of roles don’t have a whole lot of choice about being honest; it tends to lead to their, and their families’, prompt deportation to forced labor camps–if they’re “lucky.”

          • An Actual Attorney

            And where do those 500 calories come from? The average adult requires about 2000 calories a day to maintain. If a woman eats no extra food, what happens to her needs?

          • swbarnes2
          • Azuran

            So you make ridiculous claims that contradict basic laws of physic and biology and all you can come up with as an explanation is ‘I don’t know?’
            How every disappointing.

            For your info: Obviously, the more milk you produce, the more extra calories you are going to need. So yes, the cows with the high production need even more calories. But every single lactating mammals need an increased amount of calories in order to make breastmilk.

          • guest

            Dude. I produced way more milk than was needed for my two babies. Surely we’ve bred cows to select for those who do this well, and surely those cows need to eat to support their production. AS DOES EVERY LACTATING MAMMAL. Breastfeeding takes more metabolic energy than not breastfeeding. Either you’re burning fat stores, or your eating more calories than normal, or both.

          • Heidi

            What?! Breast milk has 20 calories an ounce. You can’t make that 20 calories out of thin air. I’m sure it takes a few calories for the body to synthesize that milk in addition to the 20 calories.

          • nikkilee

            Human milk varies in calorie content from 16-50 calories an ounce. Example: a participant in my class was pumping for her baby in NICU. Her milk had 21 calories/ounce in the morning, and 39 calories/ounce in the evening.

          • Monkey Professor for a Head

            Where do those calories come from? From the mother. Where does she get them from? She either has to eat more, use up her fat reserves, or lower the metabolism of the rest of her body to make up for her breasts.

          • An Actual Attorney

            And where do you think those calories come from?

          • Azuran

            So? Those 16 to 50 calories still have to come from somewhere.

          • Who?

            All this thoughtful experience and information and this is the brainsnap you come back with?

            You’re embarrassing yourself.

          • Elizabeth A

            You can’t make anything from nothing. While pregnant with my son, I gained 33 pounds. While breastfeeding, I lost 47 of them.

            I was starving hungry the entire time, and the one day I forgot to pack along snacks, I was a snarling wreck by ten a.m.

          • nikkilee

            Your metabolism is at one end of the spectrum. I’ve had clients that couldn’t gain weight no matter what. (Now I would send them to have their thyroids checked out. . . just to see if that would make a difference. Then, I didn’t know about the important role of the thyroid in human milk making and moving.) The other end is exemplified in the 7 healthy thriving babies that were discovered when the Allies liberated Dachau. All the moms breastfed, 2 moms breastfed another baby besides their own. All the babies grew up, married and had their own children. During the WWII siege of Leningrad, when people were eating bread made of sawdust, some women had so much milk that a milk bank was started to feed the babies whose mothers had died. Humans have a wide range of variability.

          • Who?

            So those few women are the source of your sweeping remark that extra food is not required to make breastmilk?

          • Elizabeth A

            Nikkilee, please compare the 7 thriving babies in Dachau with the number reported to have died of starvation there. Repeat the exercise for the siege of Leningrad, while comparing the number of infants served by the milk bank to the number of mothers donating.

            And then stop spouting these stories as though they mean anything to the women you work with. If you are telling your clients that they should be able to breastfeed even if they are starving to death, you are doing them a massive disservice.

          • nikkilee

            No. . .it was merely an example of the range of human capacity.

          • Elizabeth A

            AND IT’S DAFT.

            Not sorry for yelling.

            Look – those very sturdy specimens at Dachau and Leningrad (about which citations are violently needed), were OUTLIERS. EXTREME ONES. They don’t mean that the vast majority of women don’t need to eat more food than usual in order to reliably produce an adequate supply of breast milk for their child.

          • Amazed

            Oh I wouldn’t take the Leningrad story too much to heart. The guide might have believed it himself but the regime was very good at creating myths to elevate the spirit of its people and make them feel a part of the crowd. Their crowd, of course. Brainwashing is still strong wherever there was such a rule, it’s insane and Leningrad was in the heart of Stalin’s empire. I wouldn’t trust anything that is not verified with documents when it’s about that era.

          • Elizabeth A

            ANy story that involves bread made from sawdust should be carefully examined.

            As a first step, I suggest gathering up some sawdust and trying to make bread out of it.

          • Monkey Professor for a Head

            I could accept the idea of flour being cut with some sawdust to bulk it out, but there’s only so much you could add before the bread would become inedible.

          • Who?

            Well it wouldn’t be bread so much as sawdust pie.

          • Elizabeth A

            Right – sawdust does not behave like flour milled from grain. Too much sawdust and you go from “unpleasant bread” to “unbakeable glop.” If you’re starving, you’ll eat sawdust, but that’s true of anything.

          • Amazed

            Oh for truly hungry people it wouldn’t matter. As long as they could put it in their mouth, they would eat it.

            The problem is, is breastmilk this stupid to let itself be deceived that such a loaf is real, edible, calorie-packed food? I thought it was smarter, knowing how to regulate just to the needs of a certain infant… as well as a host of newborns and toddlers mom happened to be donating to. I thought it knew how to stop flowing when a nursing baby was full? Which one is it? Is breastmilk this wonderfully wise or this inherently dumb?

          • demodocus

            well, she did say it was alive several days ago, so maybe it does know but makes its own sacrifice. /s

          • nikkilee

            Civilians in the city suffered from extreme starvation, especially in the winter of 1941-42. From November 1941 to February 1942 the only food available to the citizen was 125 grams of bread per day, of which 50-60% consisted of sawdust and other inedible admixtures. For about two weeks at the beginning of January 1942, even this food was available only for workers and military personnel.[citation needed] In conditions of extreme temperatures, down to −30 °C (−22 °F), and city transport being out of service, even a distance of a few kilometers to a food distributing kiosk created an insurmountable obstacle for many citizens. Deaths peaked in January-February 1942 at 100,000 per month, mostly from starvation.[63] People often died on the streets, and citizens soon became accustomed to the sight of death. (from the Siege of Leningrad, in Wikipedia)

          • Elizabeth A

            Nikki, I 100% believe that people starved at the siege of Leningrad.

            I don’t believe that more than a very few babies in Leningrad were saved by donor milk from a few women who overproduced through thick and thin.

          • momofone

            I wonder if there could have been any other factors that affected survival or lack thereof in the concentration camps.

            Nahhhh. Probably just breastfeeding.

          • Monkey Professor for a Head

            I’d be very surprised if multiple other prisoners weren’t making sacrifices so that the breastfeeding mothers could get more food.

          • Amazed

            Most likely. In most camps, there were such sacrifices for various people.

          • Monkey Professor for a Head

            But let’s ignore those sacrifices in favour of “Breastfeeding = Magic!”

          • fiftyfifty1

            And “sacrifices” is an understatement. More like stopping eating entirely knowing they would die. Sisters, mothers, cousins, friends, strangers…all choosing to starve to death for the sliver of hope that a hidden baby might live.

          • Elizabeth A

            Lapka Sherpa summitted Everest six times. That’s an example of the range of human capacity.

            Doesn’t do a whole lot for my issues with running more than 5k at sea level.

          • The Bofa on the Sofa

            At some point, I am going to try to understand her arguments about populations vs individuals.

          • Charybdis

            If you do manage to understand it, would you mind explaining it to the rest of us? It would be greatly appreciated.

          • Azuran

            I think it goes something like this:
            If on a population level it’s good, Then you have to push it on an individual level because it’s good for everyone.
            If it didn’t work on an individual level, it’s not an excuse to not push it on everyone anyway.

          • Elizabeth A

            I advise (re)reading Connie Willis’s “To Say Nothing of the Dog”, and embracing its inconclusion on that point.

          • fiftyfifty1

            Oh her argument about populations vs individuals is easy enough to understand: If an individual has an experience that refutes your assertions, then wave your hands and mumble something about the importance of populations. If population data refute your assertions, then talk about Dachau.

          • CSN0116

            Well fuck me running. You need to tell the WHO and UNICEF and numerous orphanages in developing countries that there’s no need for thousands of infants to die each year from insufficient breast milk from their chronically malnourished mothers. It’s all imaginary and they just have to believe in the bullshit you’re spewing hard enough.

          • nikkilee

            I would love to see a citation about this.

          • Who?

            I may die laughing.

          • CSN0116

            About starving babies in developing countries?

          • Bombshellrisa

            http://www.seattletimes.com/seattle-news/health/designed-in-seattle-this-1-tool-could-save-millions-of-babies/
            Also babies who are preterm and can’t nurse well. 7.6 million in Africa and Asia per year.

          • CSN0116

            Does this helps you visualize what a privileged fucking moron you are?

            https://uploads.disquscdn.com/images/498902099e3cd1adbf3127afdd2c3f038e45d1359cac2e073fc598971f84e55b.jpg

          • nikkilee

            How does this heartbreaking picture of one example of two people starving to death answer my request for a citation?

          • Who?

            How does you false sympathy take the place of actual knowledge about the topic you’re apparently paid to teach, and your false concern for women trying to feed their babies?

            Admit you were wrong. Breastmilk does take calories to make.

          • nikkilee

            Did I ever say it didn’t?

          • fiftyfifty1

            “Did I ever say it didn’t?”

            Yep. Here is your exact quote:

            “Don’t need extra food to make breastmilk. Cows and dairy goats need extra food, but not humans.”

          • The Bofa on the Sofa

            You misunderstood. She is saying that women don’t need _extra_ calories. They can just rely on their reserves (and waste away, if needed)

            And she’s teaching nurses…

            In the words of baby Elphaba: “Horrors”

          • fiftyfifty1

            Horrors indeed. Lactating mothers can just rely upon their reserves, and if they don’t have reserves why then certainly some magic will come along that will “lower their metabolic rate” even though lactation is a metabolically very costly process. And if mother and baby just starve to death, like in the picture above, why then she can chide them about the Dachau example and tell them to step up their games.

          • Who?

            nikkilee
            4 (ish) hours ago

            Don’t need extra food to make breastmilk. Cows and dairy goats need extra food, but not humans.

          • KeeperOfTheBooks

            You EXPLICITLY said it didn’t!

          • Irène Delse

            Oh yes you did. Quote: “Don’t need extra food to make breastmilk”. At this point, you should stop twisting and spinning, and just go do some learning. After all, you’re the one paid to help people with feeding infants.

          • CSN0116

            Nikki millions of children die each year from malnutrition and its related complications. Only a fraction are orphaned, so they have live mothers who are unable to sustain them. Google your ass off for citations galore. This is known fact.

            God you are pompous.

            Does the fact that infant mortality rates are highest in countries where breastfeeding rates are also highest not present as a giant red flag to you?

          • nikkilee

            Topi 10 in Infant mortality

            1 Sierra Leone 107

            2 Angola 102

            3 Central African Republic 96

            4 Somalia 90

            5 Chad 89

            6 Congo, Dem. Rep. 86

            7 Guinea-Bissau 78

            8 Mali 78

            9 Nigeria 74

            10 Lesotho 73

            http://www.mapsofworld.com/world-top-ten/countries-by-highest-infant-mortality.html

            Top 10 countries in Breastfeeding Rates:

            1. Rwanda
            2. Sri Lanka
            3. 3-way tie: Cambodia, Nepal, Solomon Islands
            4. Malawi
            5. Peru
            6. Eritrea
            7. Uganda
            8. 2-way tie: Egypt, Iran
            9. Bolivia
            10. Madagascar
            http://www.therichest.com/rich-list/rich-countries/10-countries-with-the-highest-breastfeeding-rates/?view=all

            I don’t see any overlap. Where are you looking?

          • Who?
          • nikkilee

            Really?? “4. The authors ignore history. There was a time when 100% of infants were breastfed … and the infant mortality rate was astronomical because the benefits of breastfeeding are really limited.” So if a breastfed infant dies, from a fall or from cholera or from malaria or any insect born disease or from measles (a leading cause of death of children in the 1900s) . . .it’s because breastfeeding didn’t work?? I’m going to bed.

          • Who?

            Nice flounce.

            That’s your entire response? You’ve asserted that no extra food is required by women who breastfeed; that formula feeding is outrageously expensive and inconvenient; that all sorts of special ingredients are included in breastmilk that science can’t yet identify, but about which you can speak with authority.

            Pathetic.

          • Azuran

            The whole point is that the breastfeeding industry will never shut up about how breastfeeding will save kids from everything and shames formula feeding women.
            Well the graph shows that breastfeeding didn’t protect any of those kids from anything. Breastfeeding does not have any noticeable effect of child health and survival.
            It’s just not that important as long as you use a safe substitute.

          • momofone

            Oh wait–you mean breastfeeding didn’t provide immunity from malaria and insect-borne disease and measles? And it wouldn’t provide protection from a fall, as in from an exhausted mother’s arms when she’s been forced to care for him or her after a difficult birth?

          • CSN0116

            Per therichest.com: “These facts are based on women who have exclusively breastfed their babies for six months.”

            Nikki, women in the poorest nations, with the highest infant mortality rates, will not pop up the “exclusively breastfeeding at 6 months” measurement, which is a very poor one to use. Why? Because they begin supplemental feeds nearly from birth – water, ground up rice mixtures, and so on. Why? Because they do not have an adequate supply to sustain the infants.

            I’m depressed to be having this conversation with you. You actually think these people don’t exist and that breast fed babies don’t starve to death around the world. I’m done.

          • Who?

            I think the challenge in discussing this with nikkilee is that her world view is so narrow. She can’t deal with anything that doesn’t support breastfeeding. Though I note she did concede that if someone had to feed a baby bread soaked in wine, formula would be preferable.

            It’s scary to think she teaches nurses. Not because of her ignorance in her area of ‘expertise’, but because of her lack of curiosity and intellectual shallowness.

            Let’s hope she isn’t responsible for marking or grading any assessment, it’s hard to imagine anyone not parroting the party line getting a passing grade.

          • Bombshellrisa
          • Who?

            Oh dear. Oh dear oh dear.

            Professional looking website. Shame the same effort hasn’t gone into the product.

          • Bombshellrisa

            Her blog actually talks about her visits here. She doesn’t name the actual blog, but it’s not hard to figure it out with the description she gives and how she described her interactions with us.

          • The Bofa on the Sofa

            Does she mentioned that she has learned something and that her initial views were incomplwte?

          • Azuran

            It’s sad that whenever someone comes out as a nurse it doesn’t really mean that you can trust them to know what they are talking about any more.
            It’s as Nikki says in her blog: She became a nurse because her mom told her too because it’s an assured job.
            Nursing classes are sadly very easy to get into and easy to pass where I live. Becoming a nurse is like the default option for everyone without any better idea of what to do with their lives.
            I’ve met many wonderful and very good nurses. Many in my own family. But I’ve also sadly met a good number of nurses who clearly are not in the right place. And many of them sadly are just in the spot where they know a lot of stuff, but they don’t yet realize all the of stuff they don’t know.
            I’ve seen many nurses seriously hurt or kill their pets because they thought that because they were nurses, they knew what they were doing.

          • Heidi

            I just picked one country out of her list that has the top breastfeeding rates, Cambodia, and found that 45% of children under five are malnourished and their growth is stunted.

          • CSN0116

            I can’t even with her nonsense anymore. How you can look at the numbers, and look at the pictures of those starving babies, and come to the conclusion that breastfeeding always works, and it requires no calories to produce breast milk, is beyond me. It’s offensive.

            If all of those babies could have a year’s worth of safe formula, they would ALL survive that year. If their moms could all well be well-nourished, most of them could survive that year (as some women will still fail to lactate properly regardless). They have access to neither and they die or are permanently harmed.

            Which brings me to another reason that they don’t pop up on the dumb ass measurement she cited of “exclusively breastfeeding at 6 months” — because they’re DEAD by six months of age. The mothers’ attempts at dismal breastfeeding and supplementing with food that is not nourishing and inappropriate has failed and they have died.

          • Heidi

            Because we live in places where safe formula is readily we available, I think a lot of us don’t even realize how great we have it. I didn’t make enough milk and my son was truly born with hypoglycemia, despite what Nikki Lee might tell you. It really didn’t and still doesn’t seem like something that major because I got some RTF bottles, his sugar went up, I continued to supplement with formula that I can easily find made with water I don’t have to think twice about. In some of these very poor countries, this would have been a death sentence. Either he would have died of low blood sugar, been seriously injured if he did survive and then would have likely drank contaminated water and a very subpar nutritional substitute which would have been his ultimate demise.

          • Irène Delse

            I Googled “countries with the higher infant mortality”, and Wikipedia comes up with the numbers for 2015.
            https://en.m.wikipedia.org/wiki/List_of_countries_by_infant_mortality_rate
            I noticed that the top ten are not the same: it’s Afghanistan at the top 10 Sierra Leone, for instance. And it helps to see that even in the top ten countries forre breastfeeding rates, infant mortality is ten to twenty times higher than in western industrialised countries.

          • Heidi

            Yeah, Cambodia looks like a utopia! http://www.unicef.org/infobycountry/cambodia_2190.html

          • Heidi

            “Cambodia has the highest infant and under-five mortality rates in the region, at 97 and 141 per 1,000 live births, respectively. Vaccine-preventable diseases, diarrhoea, and respiratory infections are among the leading causes of childhood death. Maternal mortality is also high.

            Malnutrition affects most Cambodian children: 45 per cent show moderate or severe stunting.” – according to that UNICEF link I posted.

            Seriously. Also your link shows infant mortality AT BIRTH. This has NOTHING to do with breastfeeding. How would breastfeeding prevent a stillbirth?!!!?

          • Amazed

            Well, there was this boy in my grandfather’s village who everyone wanted to make to eat more, he was so lean. But he was in thriving health. So were many other youths who were of various built. And when they were all headed to the Communist concentration camp, our GULAG, as it’s now known, he was one of the very few who returned. Knowing what I know from another survivor, my grandfather, I’d say he was very, very lucky. Both of them were. It doesn’t mean that thet were healthier than those who died. It just means that they were lucky. They returned alive, although they both suffered from various, camp-acquainted ailments, including those of the back from dragging carts like donkeys. It doesn’t mean that the other men who were more sturdier were unhealthier.

            Do you even realize what a cynic you’re being? Comparing extreme cases from the almost most inhuman camps in history (the centres for destroying in Poland made by the same Nazis were worse, as were Stalin’s camps from whom Hitler borrowed the idea) to guilt women into thinking that even if there it was possible for mothers to make enough milk, then THEY surely can if they’re mothers enough?

            Oh, and taking one extreme, in this case the women who made too much milk for the conditions they were placed under to argue philosophically over human variability when lives and health are on the line doesn’t make you smarter. It just makes you heartless.

            If you can’t say, I find it monstrous that you’re using concentration camps – CONCENTRATION CAMPS! – to aid your agenda. I can totally see you coming over to tell my grandfather’s friends – those nice men who I remember from my childhood without a single one being unchallenged, health-wise – that they should just try harder, their bodies were made for dragging carts and look, my grandfather and the other skinny youth did it without suffering consequences THIS hard.

            Barf.

          • An Actual Attorney

            But where do you think those calories came from?

          • fiftyfifty1

            Those rare mothers were either in the process of digesting themselves to death or they were being sustained by the donations of others. Pretty heartbreaking to think of, no? The other prisoners sealing their own fates by giving up their meager rations to the nursing mothers to try to save the babes. But Nikkilee with take the results of their sacrifice and use it to bully mothers. Sick.

          • Azuran

            And I suppose you have some kind of proof that all those breastfeeding women were at top health and that none of them had lost any weight during the whole ordeal despite not eating anything.
            Here’s my guess: Sure, they produced enough breastmilk for the baby. But probably at great cost to their own health, they probably lost a lot of weight doing so. Maybe those women also actually got extra shares of food since they were lactating. But they didn’t produce the milk out of thin air.
            I’ve seen many very emaciated lactating dogs with a littler of very well fed puppies. Sometimes the body just will just keep on making breastmilk no matter what.

          • guest

            Yes, one wonders how many other prisoners in the camp gave their food to the lactating women. I find Nikki’s choice of example in pretty poor taste, frankly.

          • fiftyfifty1

            “Sometimes the body just will just keep on making breastmilk no matter what.”

            This is true. I do happen to have more experience with starving people than average due to practicing at an eating disorders center. The rule of thumb is that a typical woman loses her menses when she is 10 pounds below the minimum value of her healthy weight range. At that point the body shuts down the menstrual cycle because menses is metabolically costly, and to continue it would mean starving to death faster. But I have met a couple of patients who never lose their menses…not even at a BMI below 14. They continue like clockwork. Their bodies have a faulty safety valve I guess. The same can be true with lactation. Usually the body will refuse to catabolize itself any further, but some women may be abnormal.

          • Dr Kitty

            All the babies dying in Sudan and Eritraea and Ethiopia because their mothers AREN’T making enough milk on less than 1000 calories a day…

            Are they cancelled out because 7 babies survived in Dachau (and you DO know that those women were given extra food by the other prisoners, don’t you) ?

          • AND, how many babies died because their moms couldn’t produce enough milk in Dachau? There’s a reason those babies were seen as miracles, and it’s not because the average woman could feed a baby in those circumstances.

          • demodocus

            7 babies lived. How many died of starvation?

          • Megan

            This statement makes me doubt you’ve ever actually breastfed.

          • nikkilee

            Another evidence based comment from the Worthington-Roberts book. . .

          • Nick Sanders

            I was not aware boobs violated the first law of thermodynamics.

          • Monkey Professor for a Head

            🙂

          • Charybdis

            Some defy gravity….

          • Gatita

            In addition to all the other things she doesn’t know, Nikki is apparently unfamiliar with the first law of thermodynamics.

          • Nick Sanders

            Jinx!

          • Irène Delse

            Humans don’t need to eat extra to make breastmilk? That’s a new one! You’ll have to tell that to other lactivists who cite “losing faster the extra weight gain of pregnancy” as a reason to breastfeed!

          • rosewater1

            Uh….what?

          • MaineJen

            I guess that is why I was so desperately hungry when breastfeeding that I ate like I had never seen food before, and still managed to lose weight.

          • nikkilee

            The 500 calories a day is an average, meaning that some women will need more and some will need less. (Butte et al. 2001). The Institute of Medicine Food and Nutrition Board says, “No prescription for a set calrie level is usually made.” Lactation increases the body’s efficiency in the use of energy and the uptake of some nutrients, like calcium.

          • Nick Sanders

            “No fixed amount” ≠ “nothing”.

          • nikkilee

            Of course. Women will eat.

          • Nick Sanders

            Despite your earlier statement that they wouldn’t need to, yes, they will.

          • Who?

            Just another example of women’s selfishness, eating when they don’t need to.

            Honestly, the utter crap is strong with this one.

          • Elizabeth A

            Copied and pasted just for reference:

            nikkilee
            4 hours ago

            Don’t need extra food to make breastmilk. Cows and dairy goats need extra food, but not humans.

          • Who?

            You are a piece of work.

            I really hope you take a little more rigour and thought, and a whole lot less laziness and hubris, into training all those nurses someone is careless enough to put you in front of.

          • An Actual Attorney

            One more time, where do you think the extra calories, whatever the amount, come from?

          • nikkilee

            Food that the mother eats?

          • An Actual Attorney

            Ding Ding Ding!

            Now, can you please explain why you think human lactation doesn’t require that a woman eat extra food, that is more food than she needs to maintain her own weight?

          • momofone

            And in terms of how that food is acquired, she either has to buy it or grow it, spending money and/or energy.

          • Elizabeth A

            Which you denied was a cost of breastfeeding a few hours back…

          • Who?

            She asserted women didn’t need extra food at all. I’m sure nikkilee doesn’t begrudge their regular diet.

          • Elizabeth A

            Just for reference. Again.

            nikkilee
            4 hours ago

            Don’t need extra food to make breastmilk. Cows and dairy goats need extra food, but not humans.

          • Who?

            She will never acknowledge it.

          • Heidi

            So if the body increases its efficiency in the use of energy, that means the woman burns less calories and her body is more sluggish. Could very well be for some women, but I wouldn’t call that a positive for first world women, especially when there are claims that breastfeeding will make the baby weight melt off. When your metabolism slows down you experience more tiredness, hair loss, depression, constipation, etc. These side effects end up costing lots of money even if she can save a few extra dollars on food. I wouldn’t even call that a benefit for women in third worlds!

            Also, they may not make a “prescription for a set calorie level” because so long as food is available, most women eat when they are hungry and will naturally increase their calories to compensate for breastfeeding. That doesn’t mean it isn’t costing them more money in food. In fact, I’m pretty sure WIC allows mother more food if she is nursing, so it’s costing someone money somewhere.

          • .

          • I think my sister was EBF, but I honestly don’t remember. My mom wasn’t fanatical about it and would have stopped or slowed down if she felt her health was actually at risk, I just don’t know if it got to that point for her or not.

            I think my sister was EBF, but I honestly don’t remember. My mom wasn’t fanatical about it and would have stopped or slowed down if she felt her health was actually at risk, I just don’t know if it got to that point for her or not.

            What would you generally recommend for a woman who has lost so much weight she’s at risk of losing too much from breastfeeding?

          • Irène Delse

            First it’s “Don’t need extra food to make breast milk”, then “500 calories a day is an average”. Or maybe the goal is for the mother to not eat more and get hungry, maybe losing teeth and getting early osteoporosis, as in the days of yore? (In my country, there used to be a saying: One more baby, one less tooth.) Or, you know, buy more food for herself. Something to count when weighing the costs of breastfeeding vs formula.

            I wonder if some of your clients are reading this blog. They would be appalled.

          • demodocus

            maybe she’s thinking of all us fatties. /s

          • Irène Delse

            Heh. The next fad diet: the breastfeeding diet.

          • Azuran

            Well, you know how lactivist are always trying to shame BF mothers about their eating habits. How if you eat a hamburger when you BF you are poisoning your baby with your hamburger breastmilk?
            Well the next logical step is obviously to have all breastfeeding mothers and a breastmilk diet. After all, your breastmilk is what you eat, if you want real breastmilk you have to have a diet made of breastmilk.

          • demodocus

            It worked for me! I lost 3 times my weight gain!

          • Megan

            Ugh. Wish it had worked for me. I gained weight breastfeeding. 25 lbs. could’ve been the domperidone I suppose.

          • Azuran

            My mom gained weight with every single one of her pregnancy. Despite breastfeeding she never lost the weight she gained after her pregnancy. So she only became bigger and bigger each time.

          • DelphiniumFalcon

            Speaking of weight, my husband tripped across this last night and I think I’m going to die laughing. Sharing since I know there’s more than a few people here with Heavy Boobs:

            https://youtu.be/GYezW05zIwA

            It’s fat. Women have fat. It’s hard to get rid of/distribute to the “desirable” places.

          • Azuran

            XD that’s just awesome. And surprisingly really catchy. I’m totally sending this to my boyfriend.

          • demodocus

            I didn’t gain much in the first place because i only had anti-cravings. The loss was as much because i was too wobbly to get myself to the kitchen and make something . DH was trying, but he didn’t realize (and i didn’t realize he hadn’t) that I no longer had late pregnancy stomach capacity.

          • demodocus

            Plus, I was pretending to do a testimonial.

          • KeeperOfTheBooks

            To a much, MUCH lesser degree, of course, but I had an interesting discussion with a nutritionist I saw a year after DD was born.
            In discussing my nutritional/supplement needs (no, she wasn’t at all woo), we talked about if I was planning on getting pregnant in the next year and/or having more kids. I was a little surprised by the question, but answered that we were probably going to be TTC in the next 6-12 months, and that long-term, we would kind of like a bigger family, should that work out.
            I was concerned about perhaps getting some pushback (people do seem inclined to make rude comments about the size of your family, never mind how big it is–1 is too few, 2 are impossible or not enough, 3 is a big family or “unbalanced” due to gender, etc, etc), but she wasn’t going there at all. Instead, she merely said that I should be careful to keep taking calcium supplements, because pregnancy and, if I chose, nursing, would take calcium and other such things from me before they deprived baby, and she had had a number of women in her practice for whom large families and osteoporosis are commonly seen together because of this, and ditto dental issues.
            Of course, she was saying this to a woman who could trot down to CVS and purchase the suggested supplements and then take them with no concern for supply or how it would affect my finances. Rather different for many women in sundry developing worlds, I should think!

          • The Bofa on the Sofa

            Some may need less, but no one producing milk will need none.

            Moreover, those who are producing a lot will need more. As others have explained, the first law of thermodynamics are immutable. Increased production requires increased energy input.

            So you donors are going to need the calories to produce that extra milk.

            You better give this up. You are completely clueless.

          • fiftyfifty1

            Could it be cold fusion giving the illusion that a mother is producing something out of nothing (or maybe quantum physics, or fractals or something)?

          • Irène Delse

            Perpetual motion machines. Mothers have invented it since the dawn of time, but they won’t give up the secret to Big Energy! Oh no!

          • demodocus

            The hard part is the hamster wheels for all the toddlers

          • Busbus

            Yes, it’s an average. So? We’re talking about averages here. If 500 calories is the average amount of food a fully breastfeeding woman needs in addition per day, and we determine the average cost of that to be $2, it follows that the average breastfeeding woman will spend about $60 per month on the additional food she needs. (Obviously, that’s not even taking into account the hassle and the time lost, either for work or for rest/breaks, as well as the time the baby doesn’t get to see his/her mother and she doesn’t get to see him/her because she has to stay longer to make up for the time lost.) That’s about what we spent on formula once I had stopped breastfeeding. Interesting thought!

          • Sarah

            That is not an answer to the question you were asked.

          • Who?

            nikkilee’s specialty is not answering the question she’s asked.

            Note that her remark here is a big change from her original assertion that women did not need any extra calories to make milk.

          • Sarah

            Duly noted.

          • Bombshellrisa

            There are still people who have to pay out of pocket for the pump that will work for them. I couldn’t use anything but a Medela Symphony. $100 out of pocket per month. Plus storage bags and pump parts. Plus weekly visits to the LC.

          • Erin

            The other issue with Pumping is a logistical one.

            I quit work before my son was born but had I not, pumping would have been an impossibility despite my Public Sector workplace’s excellent pumping policy. Technically I had a desk…didn’t see it very often though and when your day looks something like this: Crisis management meeting, home visit, trip to the Police Station, home visit, Child protection meeting, home visit, home visit, Case meeting with other professionals, home visit, 5 minutes at your desk on the way home, pumping doesn’t really fit. Do you pump during a home visit to someone who has just had her children taken off her by Social Work, or perhaps during a Child protection meeting or maybe at a working lunch with a bunch of policemen and firemen to discuss community safety.

          • guest

            Walmart Parent’s Choice formula for the win!

          • Roadstergal

            I had a new-aunt friend grumble about how her sister was considering going with the cheap formula. She was astonished to hear how tightly regulated formula is. That’s the sort of useful information LCs should be giving out, no?

        • MaineJen

          Formula is not medicine, it is food. It should not have to be prescribed by a doctor.

          • nikkilee

            Everything used in a hospital (drugs, food, equipment) is purchased through a department using a purchasing system. Formula is now included in BabyFriendly hospitals.

        • momofone

          Ethically purchased? So are you making sure diapers are purchased ethically? And IV tubing? Needles and syringes? Pillows? Cafeteria food? Or is it just formula that had that unethical taint?

    • demodocus

      Sounds like good places to start. If you’ve the time, you might check out local morning shows and that sort of thing too. It might help if you can get a group of colleagues with you. Certainly diffuse the affects from the serious nutters out there on you personally

    • Elizabeth A

      While you’re in the hospital, you get to focus on taking care of yourself and your own. So don’t worry about activism. (Honestly, you’ll probably do plenty by talking to the staff about what you want from them and why, as your needs arise.)

      Bring your own formula. Definitely.

  • Anne

    My postpartum experience in a BFHI hospital evokes so many memories of pain, exhaustion and desperation. I wouldn’t wish it upon my worst enemy.

    So many issues:

    1. Breastfeeding exhaustion. Despite the breastfeeding classes, and the nurse and lactation consultant trying to help me with my latch, breastfeeding was excruciatingly painful for me. Despite my complaints of pain and exhaustion, I was told that this was all normal, and to keep persisting. The solution to the pain and poor latch and a hungry baby, was just to breastfeed more. I was breastfeeding every 1-2 hours, fortunately, with my husband taking baby in between so I could theoretically rest. However, baby basically just cried nonstop, so between the pain from my perineal tear, the breast pain, the baby relentless screaming in the same room and my equally exhausted husband unable to console her, I was a a physical and emotional mess.

    2. Jaundiced baby. When we saw the pediatrician at 48 hours, he was shocked by the weight loss and level of jaundice. Between birth and this appointment, I was attempting to feed q1h, despite it nearly killing me from pain (both from the bleeding nipples, and from deep, intense pains that felt like my breast were being macerated by ground glass)…and yet, between “feeds” my baby was sucking the air, still rooting, never ceasing to cry. I desperately kept asking the nurse if this was normal and she said, “Oh yes, you just have a difficult baby.”

    Wrong. After seeing the pediatrician, and we supplemented with our first bottle of formula, baby stopped crying. It was the first time I saw her, where she was awake and not crying. I cannot describe the immense relief that washed over me, then the anger and guilt from knowing that she had been starving for 2 days. My darling, after that, was the “easiest” baby. When my breastmilk finally came in, I still struggled with the pain of breastfeeding, but she was at least getting nutrition and at that point, was never fussy ever again! (Until toddlerhood, but that’s a different story)

    3. Pain. Despite having “just” a second degree tear…I was in an immense amount of pain. My stitches were also so tight that I had to constantly contract my perineum, so I would feel the taut stitches pulling and feeling like they were going to rip open. I had a fever, I had pain, I hadn’t slept. I was on opioids, which made the endlessly crying baby even more intolerable. I felt so much sadness and guilt for her, but it was difficult to care for her needs, when I was in so much pain myself.

    When, eventually, we found out she was starving…life got better because feeding her actually fixed her crying… However, the regimen I was put on for breastfeeding (To get her off the formula) drove me to sheer exhaustion. I was told to take milk thistle (which interacts with opioid metabolism…and resulted in apnea and me almost dying…but apparently milk is more important…), I was told to pump for 30 minutes after every q2hour feed. I didn’t have anytime to rest.

    4. Complications. Finally, when my fever was recognized…and I was placed on broad spectrum antibiotics for endometriosis, even as I was septic, volume deplete, suffering from intense orthostatic hypotension and rigors, which extended my hospital stay for a week…my baby was still kept in the same room as me, and the nurses would not take the baby! Thank goodness I had so much family support. Nurses kept coming in every two hours to make sure I was still pumping, despite being in a delirious state and wanting to just sleep.

    So yes…overall, NOT mother friendly or baby-friendly.

  • Michelle

    It sounds like from these comments that theres an issue with the hospital staff not BFHI. I had a great experience at our BFHI. 1. I didn’t want a pacifier anyway and my now 5 month has yet to be introduced to one, but the nurse at my prepare visit let me know if I wanted LO to have one that I would need to bring one, so they weren’t against them, just didn’t provide them. 2. They asked me over and over and over again if I was breastfeeding OR formal feeding. Again not against formula feeding just preferred breast, promoted and encouraged it. My milk didn’t come in for 5 days, but my baby got enough colostrum from being on the breast every 2 hours- never was even close to jaundice or dehydration, had plenty of pee diapers- I know this is not the case for everyone or every baby. I could tell though he would get a little frustrated and we had problems with latching but the nurses and LC were more than willing to help. 3. I was glad we roomed together, I didn’t really want my baby out of my sight. But the nurse the first night, a few hours after I had my son, took him with her so my SO and I could get a couple hours of sleep. They were also very much if you need help call us. Also my son’s bassinet was next to my bed so I didn’t have to get out of bed as some are saying they had to do? (which I wasn’t allowed to as I had a c-section, until late the following morning). It also had drawers with diapers and whatnot so I didn’t have to get up to get anything.

    • guest

      Why do you assume it was the staff and not the policy that was the problem for so many other people? You wanted to follow all the BFHI guidelines, and you had no problems doing so. You therefore did not undergo the treatment that so many other women have. That doesn’t mean that there isn’t a problem with the way BFHI is enforced with women who have challenges.

    • Megan

      So if you already want to do all the things BFHI requires and have no or minimal troubles doing so, BFHI doesn’t seem horrible. Shocker… /s

      Seriously though, none of us here is against not giving a pacifier, rooming in or breastfeeding if that’s what the mom/family wants and it’s working for them. BFHI pushes these things on ALL families. That’s the problem. And it’s not the staff. If you read the comments, many are FROM hospital staff who hate the things they’re required to do under the BFHI.

    • moto_librarian

      And what would have happened if the nurse hadn’t been willing or able to take your son so you and your SO could rest for a few hours? What if it took up to an hour for the nurse or LC to respond to your calls? That’s not uncommon in hospitals where nurse to patient ratios are too low.

      I think that because BFHI matched what you wanted to do anyway and because you got plenty of support, you think that this experience somehow exonerates BFHI. It doesn’t. When there is no newborn nursery nor staff to help care for babies, it’s going to be the luck of the draw. You were fortunate. Many other women here were not. Try reflecting on that for a bit.

      • nikkilee

        BFHI developed in 1991 because hospital practices were one of the top 2 barriers to breastfeeding; the other is formula marketing.

        • KeeperOfTheBooks

          And how is it not a barrier to breastfeeding to not allow mom to BATHE, for God’s sake, meaning that she gets yeast infections in, among other areas, her breast ducts? I didn’t need to fill my prescription for pain meds for pain from my CS. I seriously considered filling it in order to keep breastfeeding, because breastfeeding was so agonizingly painful that I was biting the couch cushions to keep from screaming when DD latched on and off. The sensation was like having ground glass in my breasts.
          I was told that if baby cried, I needed to nurse her. Period. I needed to do skin to skin nonstop, or my milk would never come in properly. Between the incessant nursing and screaming, I couldn’t take a shower. Wet, sugary, unwashed areas=perfect breeding ground for yeast.
          Mind you, I seem to have had more than the average number of issues with breastfeeding; my supply was extremely low anyhow, so I don’t think I’d ever have been able to exclusively breastfeed, despite wanting to so desperately. However, putting mom in a position where she can’t so much as complete basic personal hygiene or wound care lest she–gasp!–not breastfeed for twenty minutes, or stop doing skin to skin, is completely inexcusable, and if that’s what it takes to succeed at breastfeeding, it’s not worth it. (I would LOVE to see a comparable study of maternal infection rates pre- and post-BFH initiative.)
          The suggestion from the LLL leader that I must not have wanted DD enough or my milk would have come in appropriately was icing on the cake.
          Also, I do love the implication that I’m so stupid that if I so much as hear the word “formula,” I can’t possibly resist its allure and will feed it to my baby.

          • nikkilee

            It makes me sad, and ashamed for my profession to hear of such awful things. I know that they are true. I also know that more women and babies are successful with breastfeeding, for longer, than ever before. Still, lactation professionals need to learn to give service to the person in front of them. The only choices I can control are mine; I am a walk-on in her movie and this is her life.

          • guest

            Except they are not. People have posted here that follow-up studies on BFHI shows NO increase in breastfeeding once women leave the hospital.

            If you want to assist women with breastfeeding, focus on maternity leave, not fascist hospital policies.

          • nikkilee
          • nikkilee
          • guest
          • nikkilee

            Those were links to 2 studies, one from 2016, showing a positive impact on breastfeeding as a consequence of the BFHI. And, you are completely right about maternity leave.

          • fiftyfifty1

            “http://onlinelibrary.wiley.com…”

            Did you read your own link? Because it supports exactly what guest says. Hospital BFHI practices make rates look good in the short term, but don’t produce an increase in rates in the long term. What seems to influence long term rates, is practical support of breastfeeding women *in their communities*. Here, I’ll pull out the relevant quote for you:

            “Community support (step 10) appears to be essential for sustaining breastfeeding impacts of BFHI in the longer term.”

            But surprise, surprise! LCs don’t want to admit that all their hospital harassment counts for naught. So they tack on “community support” to their list of BFHI best practices and try to take credit for it!

          • KeeperOfTheBooks

            Oh, there were “community support” lactation consultants in my area that I could have talked to after I was discharged.
            ‘Course, they also charged $400/hour, so it’s a bit beyond me how they could claim to be accessible to most people.

          • demodocus

            Do random strangers coming up to me to congratulate me count as support? Struck me as rude.

          • KeeperOfTheBooks

            As I understand it, in order to breastfeed you receive nonstop affirmation of The Correct Choice (TM) because the only reason random strangers don’t walk up to you to affirm your choice is, obviously, that they must all secretly hate, fear, and judge you, not that they’re minding their own damn business and thinking it’s generally considered inappropriate to comment on or inquire about a stranger’s body or sex organs.
            This also often applies to the more rabid natural birth types, FYI. I’m reminded of my best friend’s husband, who foolishly said, “Cute baby! Congrats!” to a mom at church he knew almost entirely by sight when she walked into the cry room with a newborn one morning. The poor guy then got a contraction-by-contraction description of the kid’s waterbirth, down to details regarding tearing and so forth. Apparently his stunned expression meant that he wasn’t supportive…I’m sure it had nothing whatsoever to do with not wanting to know the state of a near-stranger’s perineum!

          • Megan

            Don’t forget about how “community support” also means strangers come up to tell you when you’ve made The Wrong Choice (TM). That’s the lactivist’s favorite kind of support, hence nikkilee and all of her BS about the inferiority of formula fed kids.

            You know folks, we won’t change nikkilee’s mind. Her income depends on it.

          • nikkilee

            More babies leave the hospital being breastfed in a BabyFriendly facility. What happens next is up to community. Community is friends, family, social networks and they are more significant in a mother’s life than any healthcare professional. That is why community networks are Step 10 of the 10 Steps to Successful Breastfeeding, the heart of the BFHI.

          • momofone

            “What happens next is up to community.” Or maybe the parents?

          • KeeperOfTheBooks

            Of course they breastfeed more in the hospital! If you had to sign a form saying that you understood you were causing your child irreparable mental, social, and physical harm by formula feeding, you’d breastfeed in the short term, too. If you had to listen to lectures about how only bad moms formula feed and all women make enough milk to feed their babies if they just try hard enough, you wouldn’t ask for formula, either.

          • Elizabeth A

            Interesting. So LC’s influence stops at the hospital door, and what happens after that is someone else’s fault. AKA we don’t need to examine whether we’re actually doing our patients a service, we’ve decided that what happens outside the hospital doesn’t count.

          • nikkilee

            All hospitals can do is start things off right. Of course we need to examine what is happening in the hospital (poor management in hospitals keeps LCs in private practice in business. . . .I’d love if this went away!). . . . AND once she gets home, she (the mother) needs practical advice and encouragement to keep going. That’s outside the scope of hospitals.

          • momofone

            “Right” meaning the way the hospitals want things to be, or the way the mother wants them to be? And what if–crazy idea–the mother gets to choose what she needs when she gets home, instead of having someone decide that for her?

          • D/

            Yep, my partners and I have come to “affectionately” refer to the short term approach of a pin-hole focus on no food or drink other than breast milk, unless medically indicated (Step 6) as the ‘supplement at the flagpole’ plan. Nothing but breastmilk for the duration of the hospital stay, give a couple formula nursettes at discharge, and recommend pulling forward to the flagpole from the hospital’s front door and stopping feed your baby … because he needs it.

            Violá, increased rates of exclusive breastmilk feeding … *during the hospital stay*. JCAHO quality measure reporting solved 🙁

          • D/

            Just to clarify, families would never be encouraged to actually stop in the drive-thru to feed their babies … they’re being encouraged to supplement as soon as they get home. We’ve just adopted the flagpole feeding codeword amongst the LCs for the babies that really shouldn’t be made to wait (and often don’t if mom just needs “permission” to go ahead and feed the kid while they’re waiting for discharge.)

          • demodocus

            My plan was to bf long before I got pregnant. BFHI had no relevance. Neither did the zillion books and articles I wandered across while pregnant. This despite the fact that I only knew for sure of what one woman did to feed her kids because Mom had my brother when I was 10, and it was hard to miss. The LCs were …less than helpful. My son’s male pediatrician is the one who actually helped.
            Quite successful, in that he was a well fed baby, except that I grew to hate bf’ing with a passion equal to the heat of a thousand suns.

          • nikkilee

            What about it drove you to hate?

          • demodocus

            A deeply personal question I don’t feel like sharing with you.

          • Charybdis

            I also intended to breastfeed, but I also wound up hating, loathing and despising it, even though I had a lot of breastfeeding “support” as you like to call it.

            What I wanted and needed, in hindsight, was VALIDATION that breastfeeding was hard, that it was not working out for me and DS and that it was okay to stop. Which I did not get. I got the LC/Lactivist party line of “feed more, pump more, lay in bed with baby and nurse, nurse, nurse, try some fenugreek, mother’s milk tea, oatmeal, nurse, try different nursing positions, use support pillows, constantly hold DS, etc”. All that did was piss me off, because I *had* been doing/trying all that and it was not working.

            I hated smelling like a milk machine. I hated that I couldn’t get a shower or anything else done, as I was always trying to breastfeed. I hated being sticky and that I couldn’t get any sort of routine established because of the constant breastfeeding that was not providing DS with enough to eat. I hated being the only person who could feed DS, I hated having a boob ornament attached to me at all times, I hated not having any personal space, not having 5 consecutive minutes to myself and no order to my day.

            I wanted someone to validate my feelings, tell me that it was okay to stop and that breastfeeding was not always easy, or not always possible for women. Instead I got the “99% of women can breastfeed successfully, just keep trying” garbage. Nobody in the “support” group ever gave a damn about my feelings and treated me like a milk dispenser that needed adjusting/fixing. I had supply issues and some letdown issues, as I’m pretty sure my milk never let down completely, ever. After about a month of insanity, I chucked in the towel and switched to formula completely. It was such a relief.

            If I ever have another child (unlikely), I will EFF from the start because my first experience was such a shambles. It would give me a perverse pleasure, giddiness even, to NOT contribute to a hospital’s BFHI exclusive breastfeeding rates.

          • Bombshellrisa

            The sensation of milk letting down felt like needles coming through my nipples. Every. Single. Time.

          • Erin

            It was hugely triggering for me. Every time I put my son to the breast I saw my rapist, obviously not helped by the fact that he arrived with a full head of hair (which shouldn’t have been a surprise because I was born with lots of dark hair too). Yes, I wasn’t very well at the time but my obvious mental health issues were ignored because apparently breastfeeding even when it’s part of the problem fixes everything.

            I kept at it for 3 months, beating myself up, hurting myself physically afterwards, hating myself and him for being hungry.

            Then I berated myself because he was going to be obese, diabetic, asthmatic, stupid…

            If I have another, my plan will be formula from the outset and whilst I may change my mind if the second baby arrives in a less traumatic fashion, no amount of cheer leading from people who clearly don’t give a damn about me or my children will play a part in my decision making. When it comes down to health “care” professionals putting statistics ahead of the mothers and babies under their “care”, then something is hugely wrong with the system.

            I spent Friday with a friend of mine, her child is a few days younger than mine. The development gap is months apart though which when you’re talking 15 months old is massive.

            You want to know why…well it’s because of people like you. You see she lost over 25 percent of her birth weight in the days following birth because despite her PCOS mother’s concerns healthcare “professional” after healthcare “professional” kept telling her everything was fine. Only it wasn’t.

            By the time she was readmitted to the hospital some unrecoverable damage was done. They don’t know the full extent of it yet, but she can’t stand up by herself, let alone walk. She doesn’t vocalize but she has the sweetest smile. I held her for half an hour, whilst her Mother had a cup of tea and she’s half the weight of my son. A tiny little thistledown girl who deserved better.

            Her mother is a nervous wreck who spends half her time beating herself up and the rest panicking about what she’s going to screw up next. She deserved better too.

          • fiftyfifty1

            ” I also know that more women and babies are successful with breastfeeding, for longer, than ever before.”

            And yet, despite all the work that LCs do to try to increase breastfeeding rates, they still can’t come anywhere close to matching the rates of 2 major immigrant groups in my area. One group routinely and generously “tops off” all babies with formula until milk comes. The other actually believes colostrum to be harmful and babies are not put to the breast at all until milk is in (I bet you can imagine the hysterics this causes in the LCs)! Both groups politely decline the services of LCs, and both groups go on to have high breastfeeding rates well into toddlerhood.

          • KeeperOfTheBooks

            Assuming that more women and babies are successful at breastfeeding since before the BFHI, which I find unlikely, does that excuse making new moms’ lives near-universally hell just when they’re at their most vulnerable?
            This stuff also turns at least some moms off of even trying next time around. I’m simply not up to dealing with the guilt-tripping and nastiness again. If the LCs would agree not to do their best to make me suicidally depressed about what a horrible mom I am two days into new-mom-hood, I might be willing to give breastfeeding a try again: as my OB pointed out, while it’s my decision, second-time moms often have it easier. However, trying to breastfeed means having someone constantly in my room telling me that if I fail again, my kid won’t bond to me, will be sick all the time, and if I just tried harder, it would work. (How one can try harder than nursing for 60-75 minutes, pumping for 30, wash the pump/peeing/other necessary stuff for 15, and start the cycle again is well beyond me, but what do I know?) Not happening. Never again. And I make a point of being supportive of new moms, regardless of their feeding methods, while warning them about what sort of “support” they can expect if they ask for help from a LC at our local hospitals.

          • nikkilee

            I wonder what percentage of new mothers have this type of experience.

          • Monkey Professor for a Head

            Is there a percentage other than 0% which is acceptable?

          • Megan

            Don’t know, but my experience was similar. Second time I tried, baby got colostrum and I still only made 8-12 oz a day, just like the first time around. Baby still lost weight combo feeding so we changed to EFF. Best decision I ever made. I’m enjoying my baby. My toddler gets attention. My husband can help more. You’ll never convince me that my beautiful daughter is the scourge on society you make FF babies out to be.

          • StephanieA

            My experience sounds similar to yours. My baby (I think he’s a bit older than your daughter?) was breastfed for a month but I just didn’t produce enough for him. He was constantly hungry. He’s a perfect little FFchunk. My 2.5 year old was EFF and he’s rarely sick, super skinny, and a beautiful little boy. I dare someone to tell them that lack of breast milk has hurt him in any way.

          • KeeperOfTheBooks

            As do I.
            It’s pure anecdote, but I’m a woman of young-ish childbearing age, meaning that I have quite a lot of friends who are in the process of having babies. In the last year, five friends have had new babies. Of them, all planned on breastfeeding; in three cases, these were second or third babies whose moms had successfully breastfed in the past.
            In one case, mom simply threw the lactation consultant out of her room because the last time she had anything to do with one at the same hospital, she ensured that her baby got re-admitted due to jaundice. Mom and dad have incompatible blood types, and mom’s milk, while it always comes in and plentifully so, does not come in for the first week or thereabouts. The blood type thing means that their babies are at a higher risk for jaundice. When baby’s bili numbers started to rise despite constant nursing, the pediatrician told mom to give a bottle or two. No problem for mom: this happened, as I said, with her past babies, and she always ends up exceeding her initial breastfeeding goals because once her milk belatedly arrives, she finds nursing easy and pleasant. However, the lactation consultant/nurse refused to allow them to feed the baby a bottle despite the pediatrician’s orders because “this is a breastfeeding hospital.” Mom finally got an early discharge “to work on nursing at home,” took baby to the pediatrician’s, and by then, baby’s bili numbers were high enough to require re-admission. To be fair, the ped raised hell with the hospital for this stunt. BFHI hospital, mom ended up meeting her nursing goals.
            In another case, baby was sent to the nursery because mom was taking some time to come out from anesthesia. When mom started to be lucid for a few minutes at a time, the LC and nurse constantly rode on her to pump, pump, pump…and neglected to mention that oh, by the way, we’ve transferred your baby to the NICU because we think he may have pneumonia. After all, mom knowing her child’s medical condition or recuperating from anesthesia was far less important than her ability to produce milk! Hospital is working on acquiring BFH status; Mom didn’t nurse or pump again after day 2.
            In a third case, baby was sick because of an infection mom had. Mom wasn’t allowed to hold him while he was in the NICU, and was recovering from an assortment of issues herself. Still got harassed nonstop to pump, pump, pump, though. She didn’t mind pumping; in fact, her plan all along was to start pumping early to prepare for returning to work. She did mind being treated like a bad person because her milk took a couple of days to come in. I think, but am not certain, that this was a BFHI hospital. Mom exceeded her breastfeeding goals, and ended up donating several dozen gallons for preemies at a milk bank.
            In the fourth case, mom nursed from the start and had few problems. That the nurses were very supportive helped: of course, cluster-feeding was tiring, but they were happy to take baby long enough for mom to eat, shower, and nap for an hour or so from time to time over the course of her two-day stay. Mom still raves about her awesome experience there. Non-BFH, mom is still nursing and, based on past experience, will likely do so through toddlerhood.
            In the fifth case, one about which I’ve posted here recently, mom had a C-section and required high doses of both painkillers and anti-anxiety meds which knocked her out for the rest of the day. She was intermittently conscious by the evening, but would fall asleep mid-conversation. She couldn’t get out of bed, of course. Nonetheless, her nurse a) refused to allow her support person to stay to help with baby (might interfere with bonding, don’tchaknow, and how dare the support person be a sister rather than a spouse), b) said that the sister should just wait in the waiting room all night, and if mom needed her, she could call her to come back for a little while (mom can’t maintain consciousness reliably, but I guess her sister’s supposed to psychically know when she’s about to drop her baby and run back there?), and c) refused to have baby taken to the desk or nursery because mom just needed to learn how to care for baby. Fortunately for all concerned, the night nurse had both a brain and a heart, and broke hospital policy to allow sis to stay, and even offered to walk baby in the hall for a couple of hours to let mom and her sister get consistent rest. A day later, mom’s nipples were raw, bleeding nubs from constant breastfeeding. Her sister, who has successfully nursed three kids and had similar issues with her first, suggested a nipple shield; the lactation consultant and nurse said that wasn’t allowed because then baby would have to be weaned from it and a nipple shield isn’t “natural”; mom just had to get past the pain. BFH. Since mom wasn’t “allowed” to use a nipple shield, she went to straight formula by day 4.

          • StephanieA

            A lot. I’m 27, have two young kids and lots of friends with young kids. So many women have experiences like this, myself included.

          • Elizabeth A

            You should be enraged.

            And you describe yourself as teaching other lactation consultants. Do you agitate for them to make decent choices? Seems like you could.

            When my son was born, the lactation consultant came in just before we planned to leave. She inspected my underwear, insulted my mother, and insisted that I wasn’t latching the baby on correctly. After an hour of popping the baby on and off my nipple while the LC sucked her teeth and declaring the latch not quite right, I gave my son the only ounce of formula he ever had. The next day, a visiting nurse came to our house. She told me that if the baby was swallowing (he was), and I wasn’t in pain (I wasn’t), she didn’t see how there was any cause to worry about his latch. We nursed for nearly two years with no further interference.

            When my daughter was born – close to 2 months early – I saw an LC for 5 minutes maybe. My insurance wouldn’t pay for me to rent my pump from her company, and I didn’t need a hands free bra because I had a bunch already. After she determined she couldn’t sell me anything, she vanished. And at that, she was better than the LC I saw when my son was a newborn.

          • nikkilee

            What I teach, what people hear and what they do in practice are 3 different things. I do teach that there are 2 rules of breastfeeding: 1) mother is comfortable and 2) baby gets milk. What else do you need?

            Hospital systems don’t always give LCs enough time to give best care. What is supposed to happen is that bedside nurses are to help with breastfeeding, and the LCs are the clinical specialists to take care of special circumstances: baby in NICU, mom with persistent challenges etc. etc.

            What often happens is that nurses don’t help because they are often overworked (worked 1.5 to 2.0 FTE) , and everything breastfeeding related gets put on the LC. Sitting with a new mother can take an hour; when there are 10 or 20 or 30 new moms to be seen on one shift, there isn’t enough time for this to be possible.

            Not all hospitals are this way, but many in my area are. Remember that one way hospitals save money by cutting back on nursing staff, and some hospitals don’t have LCs or hire LCs but don’t pay for enough hours to provide full-time coverage. It’s news in my community when a hospital has a LC for nights!

        • Bombshellrisa

          How does formula feeding affect how fast a woman’s milk comes in or how much she can supply?

          • guest

            I can answer this. The ideas LCs have is that nipple stimulation is required for milk to come in, and to increase the amount of milk a woman produces over time. There is at least some truth to this – *some* women can increase their supply using a breast pump for extra sessions.

            Their fear of supplementing is that when you give the neonate formula, you are missing out on the crucial nipple stimulation. The ones that are against supplementing think that if you miss one feeding because you “fear” low supply, then the next time you want to breast feed, your supply really will have gone down, so you’ll supplement twice as much, and on and on until breastfeeding completely fails.

            There is a tiny bit of truth behind it. If you don’t stimulate the breast, it will eventually stop producing milk. But the problem is that they assume women who supplement with formula aren’t getting enough breast stimulation. But what is “enough”? My hospital LC had me frantically pumping while separated from my babies and I ended up with an *over*supply, so it is in fact possible to have TOO MUCH stimulation. It is possible also to have too little, but it does not follow that supplementing with some nursing/pumping sessions in the first week would automatically lead to complete drying up of milk, or inability of the breast to increase supply as time goes on.

          • Bombshellrisa

            I meant to write “formula marketing”, oops.

          • FEDUP MD

            Yeah, with the first baby I was browbeaten into pumping like crazy before my milk came in to make sure I had a good supply. When it came in, I had massive oversupply which lasted for months. By the second kid, they were still on my case to pump through the day and night, but this time I knew better. With no pumping, just putting the baby on every so often, I had the most unbelievable oversupply and engorgement, to the point where I felt physically ill and actually got bilateral brachial plaxopathies from the underarm portion being so swollen. If I had pumped every 3 hours like I was “supposed to” and harangued about even as an experienced mother, I do wonder if my breasts would have literally exploded (I do have stretch marks on them from that time).

          • nikkilee

            http://www.ncbi.nlm.nih.gov/pubmed/24529621 In hospital formula use affects a woman, somehow. Again, populations, not individuals.

          • The Computer Ate My Nym

            Two potential explanations for this finding:
            1. Women who have trouble breast feeding are more likely to need formula supplementation. Some of them will have only temporary problems and will go on to exclusively breast feed later on. Others will continue to have difficulty and will quit. Women who had an easy time early on will be more likely to continue to have an easy time.
            2. Formula feeding is so much easier and more convenient that any woman who tries it will be “tempted” to continue it.
            Even if the latter explanation is the correct one, what’s the problem: The women who stop breast feeding are happily and adequately feeding their children. The women who continued breast feeding are doing same. I don’t see what the issue is.

          • nikkilee

            Formula supplementation is nationally given to about 75% of breastfed babies (CDC statistic) because healthcare professionals don’t understand or are ignorant of breastfeeding. Baby has low blood sugar? “Give formula.” Baby has jaundice? “Give formula.” The idea of putting a baby skin to skin to raise its blood sugar, or supplementing with human milk (from a donor milk bank or Prolacta) or from mom is nationally, not standard practice. The only thing easy about formula feeding is that anyone can do it. Formula fed babies are sicker, more likely to be hospitalized. How convenient is a sick baby? Who stays home from work when baby is sick? 3 of the top 5 reasons the US spends money on sick children come from conditions that would be reduced in number if babies were breastfed according to recommended guidelines. http://meps.ahrq.gov/mepsweb/data_files/publications/st434/stat434.shtml

          • momofone

            Surely you aren’t promoting breastfeeding as a more “convenient” option? (Of course you are.) I did it for a long time, and I’m not sorry, but there was nothing convenient about it. There’s not much convenient about babies, no matter how they’re fed.

          • nikkilee

            Convenience is in the eye of the beholder.

          • momofone

            Of course it is. Yet I hear you citing convenience as a reason to breastfeed. “The only thing easy about formula feeding is that anyone can do it. Formula fed babies are sicker, more likely to be hospitalized. How convenient is a sick baby?”

          • demodocus

            my anecdote comes in the form of a grim joke from my mother-in-law. “I just prayed [my DH] would be healthy; I should have been more specific.” EFF and healthy as a horse. If it weren’t for the congenital blindness, he’d barely have seen a doc before he broke his arm in middle school. Me, I was EBF’d, with a mild prematurity related heart condition (it corrected before school), asthma, and went deaf on one side from scarlet fever.

          • BeatriceC

            All my kids were breast fed from the tap or from expressed milk in a bottle for at least six months. Yet one of them now has an intestinal mass and the other two have orthopedic surgery a few times a year. Breastfeeding certainly didn’t stop all that.

          • momofone

            I breastfed for 21 months. Four years later I had bilateral mastectomies, much to the horror of some lactivist friends who were convinced that breastfeeding was not only imbuing their babies with magical protection, but them as well. But hey, we’re just a couple of individuals, right?

          • Elizabeth A

            I breastfed for a cumulative 3 years (slightly under 2 years for my son, slightly over 1 for my daughter). Was diagnosed with stage 2 grade 3 BC about 1.5 years after my youngest weaned. It turned out that my right breast – the one with the hideous oversupply, which is an interesting coincidence – contained malignancies throughout the milk ducts, and I was lucky I didn’t have to have pectoral muscle removed.

          • momofone

            But…but…you breastfed! Are you sure you didn’t do it wrong?

          • Elizabeth A

            Momofone, I blame the c-section. If not for the c-section, I’m sure I never would have developed breast cancer, and poor little DD would never have to think about that risk in her own future. We’d be so much more one with nature.

          • momofone

            Damn it. I should’ve known it was the c-section.

          • demodocus

            My sister developed a low grade (don’t know which specifically) breast cancer in her early/mid 20s, and stage IV ovarian while pregnant with her first and only at 28. I give a nasty eye to the posters that trumpet reduced cancer risk.

          • The Computer Ate My Nym

            Was it hormone receptor positive? Please do feel free to tell me where to go if you don’t want to answer, but I’m curious because I suspect–and there is, I think, some evidence–that if there is a reduced risk of BC with breast feeding, the reduction is probably only for ER and PR positive tumors.

            Glad it was caught at stage II and hope you’re doing okay now!

          • The Computer Ate My Nym

            And it appears that I am completely wrong and in fact had it backwards. This is why one should get the data and not count on anecdote or non-specific memories.

            http://annonc.oxfordjournals.org/content/26/12/2398.long

            I have to say, though, it doesn’t look like a huge effect overall and a number of studies don’t show any effect at all. Certainly not an absolute protection.

          • Elizabeth A

            I don’t mind taking about this. My cancer was very slightly PR positive and intensely Her2/neutral pos. Treated as her2+, and I’ve been NED for 3 years now. Herceptin is amazing stuff.

            We really only caught it because it went symptomatic. I’d had a lump checked out four months earlier was told it was probably cystic breast tissue, and resolved to think no more about it. If it wasn’t for body discharge from the nipple I wouldn’t have gone back. So, you know, follow up aggressively on persistent lumps. Whether or not you have risk factors (I didn’t ).

          • Charybdis

            Formula feeding was hella more convenient than breastfeeding. The lactivist party lines of “Boiling water! Sterilizing bottles! The measuring! The mixing! The heating up! The cleanup! Having to carry a ton of stuff with you when you leave the house!” are just about as out of date as the NCB’ers idea of hospital birth.

            Bottled or distilled water for mixing, dishwasher to clean and sterilize bottles and nipples, RTF doesn’t need mixing and the powdered formula is pretty easy to measure out (1 scoop for 2 oz water, 2 scoops for 4 oz water, etc.) and store in bottles. Not exactly the “oh, so complicated” scenario lactivists paint formula feeding to be.

          • nikkilee

            Powdered formula is not sterile. It can contain spores of clostridia, cronobacter or salmonella; safe preparation of powdered infant formula is important. http://www.cdc.gov/features/cronobacter/

          • Charybdis

            This is why they make RTF and liquid concentrate as well.

            Are Moms’ nipples sterile? How about their breastmilk when they have cracked and bleeding nipples or mastitis? Or do they somehow have a Brita ™ filter and sterilizer inside their breasts? Oh, and yeast from thrush? Because it seems like breastmilk that contains blood (strawberry milk!!), pus and yeast could cause issues as well. But what do I know? I’m not an LC.

          • guest

            And, for that matter, how sterile are a mother’s hands when she picks up her baby, or when she touches her own breast getting it out for a feeding? How sterile are mommy’s lips when she kisses her baby? How sterile is the pacifier? How sterile are the clothes baby wears? How sterile is the bassinet? How sterile is the diaper on baby’s bottom? How sterile is baby’s three-year-old sibling who likes to touch the baby in all kinds of ways? How sterile is the family cat? How sterile is the water baby is bathed in?

          • Bombshellrisa

            My sister in law got pink eye from changing poopy diapers. Exhaustion makes you forget to wash your hands.

          • guest

            Exhaustion, and also the fact that you wash your hands so much they are raw and chapped and so maybe sometimes when you don’t think you got any waste matter on your hands you skip it, just this once…

            Two in dipaers, man. The skin of my hands is never going to recover.

          • Megan

            My toddler can never leave her baby sister alone. She’s been kissing her multiple times a day since the day she can home from the hospital. She doesn’t care if snot is flowing out of her nose, her love for her sister knows no bounds! But it my baby gets sick, I’m sure it’s cause she’s FF, right?

          • Bombshellrisa

            Has to be that. Well, either that or the fact she was an epidural drugged, c-section born baby.

          • Megan

            “Powdered formula is not sterile.”

            Neither is breastmilk you get off of Craig’s List.

          • Bombshellrisa

            Don’t we have all kinds of bacteria and stuff on our body at any given time? How sterile is a nipple that is raw and bleeding?

          • fiftyfifty1

            “Neither is breastmilk you get off of Craig’s List.”

            Neither is the breastmilk the baby gets right straight from the boob.

          • demodocus

            especially if you have mastitis or open wounds from bfing

          • nikkilee

            Right. Breastmilk purchased from anywhere except a HMBANA certified milk bank or Prolacta or Medolac is not safe. Breastmilk given away for free can be safe. Powdered infant formula is can make babies sick. . . .Walmart had a big recall of powdered formula in 2012 for this reason. I gave the CDC citation about already.

          • Nick Sanders

            That’s a lot of reliance on possibilities without any actual backing with data on likelihoods.

          • Megan

            I was given breastmilk by a friend who had all negative testing at the beginning of her pregnancy. Her husband cheated on her while pregnant, unbeknownst to her when she gave me the milk. Shit happens and it can happen to anyone. If the milk isn’t screened, there’s no way to know. Plus, there is not enough safe donor milk to go around. It should be prioritized for premise. Term infants will be just fine on formula. Demonizing formula only encourages breastmilk to be sold at $3-4/oz online due to high demand rather than donated to safe milk banks.

          • Monkey Professor for a Head

            I had a blood transfusion last year. If I had been told that I was going to get unscreened blood from a family member or friend (even if they had been tested 9+ months previously), I would have declined and just put up with the anaemia.

          • Megan

            Yes, I now deeply regret giving my daughter donor milk and wish infuse given formula. I did my daughter a disservice by putting her health at risk and I’m very ashamed of it. I bought into it because of the rhetoric surrounding breastfeeding and demonizing formula. I share the story because I hope it will help people realize that the safety of unscreened donor milk is not guaranteed. I am not proud of it.

          • Monkey Professor for a Head

            Crap, sorry, I didn’t mean to sound like I was judging you. I was just trying to explain why I’m wary of informal milk sharing I general.

          • Megan

            Oh I know you weren’t. I just still harbor a lot of guilt about it. Id never do it again and while I was ashamed to admit I put my daughter at risk, I hope my story helps people realize that no matter how safe you think it is, you just never know what’s really going on (and anyone can get cheated on). My daughter seems fine this far, but she could’ve gotten HIV in a situation like that.

          • momofone

            How many were sickened?

          • Elizabeth A

            How does being FREE make informally donated milk safe?

            I donated milk because I had a ton extra. I felt confident about the safety of my own milk – I was feeding it to my own baby, after all – but other women had to take my word for it. When I needed to stop pumping for my daughter, I wasn’t personally comfortable enough with donor milk, and the idea of driving hours at someone else’s conveniences to hopefully wind up with enough breastmilk to feet my baby whenever she was hungry was just too much to cope with. My daughter thrived on formula, and it is what I recommend to families who need to supplement.

          • nikkilee

            Because in situations where mothers are selling their milk (as was done in Brazil, and is now occurring here in the US), folks have adulterated or diluted their milk. It isn’t stored properly, especially when shipped.

            When milk is given away locally, mothers form relationships. A mother can see how another mother lives, and see how her baby is growing.

            Nothing is without risk. Adult humans can, if given all the information, choose what is best for them.

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3395287/

            Safety is addressed by this informal sharing network:
            http://www.eatsonfeets.org/

          • Elizabeth A

            In order to get breast milk from informal sharing networks, one of the woman I donated to drove an hour each way. She had no idea how my baby was doing. (In fact, my breastfed preemie was in the hospital at the time.) Mothers do not necessarily form relationships just because they share breast milk – they find each other on the internet and add to their errand lists.

            And there was nothing to keep me from storing my milk improperly, or from diluting or adulterating it.

            The thing you’ve linked me is basically an ad for a Facebook group for milksharing. When I clicked around and found their safety recommendations, I noticed that there’s no enforcement mechanism. I donated milk via LJ communities in 2009,and while much was said about the importance of screening and voluntary disclosure, nobody ever asked me if I had been recently tested for anything. The only questions I was ever asked were “when can I come get the stuff?” and “Can I bring you anything?”

            I have been in these milk sharing networks, and frankly, I believe you are looking at them through the rosiest of rose-colored glasses.

          • An Actual Attorney

            Would you tell your children that if their intended sexual partner looks healthy and lives a middle class lifestyle, there’s no need to use condoms? After all, no one who formed a relationship ever got an sti.

          • Who?

            Exactly.

            I wonder too-if you’re asked to donate breastmilk by a friend or family member, and you know, or suspect, you might have been exposed to an sti-how you would get out of saying yes.

            You won’t want to admit to the risk, probably; you won’t want to say a flat no. Hopefully you wouldn’t be breastfeeding at all in that situation, but life does get complicated.

          • An Actual Attorney

            And possibly there’s mental health meds, or any meds, even otc stuff, that you might not be keen on discussing. Not to mention that the reason we test people is because we don’t automatically know that we have been infected. I know a lot of US jurisdictions still require negative syphilis tests before issuing a marriage license.

          • BeatriceC

            Human nipples aren’t sterile either. Your point?

          • Megan

            “safe preparation of infant formula is important”

            So perhaps it should be taught to parents. We know that most babies get some formula during their first year. BFHI instead pretends that FF can just be banished.

          • guest

            And exactly how many times has that caused illness or death in a baby in the United States?

            Oh, I can answer that: We have no reported incidents of harm as of yet.

          • nikkilee

            Actually there are reports of deaths from all over the world. These deaths were the reason the WHO came out with their guidelines for prepration of powdered infant formula in 2004. The WHO has since upgraded their guidelines http://www.who.int/foodsafety/publications/micro/PIF_Bottle_en.pdf

            True that these deaths are rare, and they do occur. In some cases it is the method of formula preparation that has led to the infection, in other cases, the powder itself. http://www.bloomberg.com/news/articles/2011-12-28/bacteria-tied-to-baby-s-death-has-been-linked-to-formula-since-1980s

          • momofone

            How many cases of this have you seen in your personal, firsthand experience?

          • guest

            But you have none in the United States, which is the only place I asked about.

          • Bombshellrisa

            We had it down to a science, we would measure out hot water and put it in the padded thermal pocket that came with the diaper bag and then put the formula in a 60ml container. When it was time, we just poured the formula into the water and shook it. Voila! My parents refused get so fancy and just had bottles of RTF around for when my son was there to visit.

          • KeeperOfTheBooks

            Quite. When FFing, I could toss a container of premeasured formula, a bottle of water (if I was going to be somewhere where I wasn’t sure about water availability), and a clean bottle into my bag. When DD got hungry, it was a question of pour water into the bottle, add formula, shake, and DD was fed in less than ten minutes.
            When combo-feeding (never had enough supply to straight-up breastfeed), I had to pack all that plus had to plan well in advance to make sure I’d have a separate room available for breastfeeding. (I don’t care if someone else nurses in public, and they’re more than welcome to, but I was never comfortable with it for myself.) I’d have to time everything just right so that I wouldn’t go at all late on the feeding and risk yet another plugged duct/round of mastitis. I’d generally end up sitting hunched over on someone’s bed, my back giving me hell, fighting DD to get her to latch because if she didn’t, I’d get sick again. Then after she’d spend an hour or more nursing, I’d still have to make up the bottle and give it to her, and then repeat it all an hour or two later.
            It was no way to live.

          • StephanieA

            Yeah. I remember sitting in a dark bedroom at a family party breastfeeding my son because the men at the party weren’t comfortable with it (even if they were I don’t really want my grandfather to see my boobs). Bottles aren’t inconvenient for me. My husband does a lot of the dishes, we have lots of bottles, and I don’t have to hide at family gatherings.

          • AllieFoyle

            Exactly. Which is why women’s choices should be respected on an individual level. If a woman finds breastfeeding inconvenient or undesirable for herself, that should be respected and taken into consideration in research and policy. The situation now is that women’s individual choices not to breastfeed exclusively are viewed as a public policy problem to be fixed on the population level. Do you see how that is problematic?

          • nikkilee

            Public health policy aims for the ideal, the best health for the most individuals. This means change. For example, doctors were featured in cigarette advertisements in the 1950s. “Smoke Chesterfields to calm your nerves. The tobacco is toasted.” New information leads to new policy; it takes generations for the public to make change. This is true for the Back to Sleep campaign, for example.

          • AllieFoyle

            Any public health policy that is based on biased interpretations of data and that ignores fundamental issues of bodily autonomy and personal decision-making is problematic, in my view.

          • Bombshellrisa

            Those weren’t doctors, they were actors dressed up as doctors. Hence why anyone on tv in commercials has to say “I am not a doctor” now.

          • Irène Delse

            I shouldn’t be surprised that nikkilee conflates “public health policy” with cigarettes ads.

          • Box of Salt

            nikkilee “it takes generations for the public to make change. This is true for the Back to Sleep campaign, for example.”

            How are you counting generations?
            Back to Sleep started in 1994. By 2008, SIDS was down “from 1.34 per 1000 births in 1991 to 0.64.”
            http://www.jwatch.org/pa201204250000001/2012/04/25/how-risk-factors-sids-have-changed-back-sleep
            That’s just ONE generation, nikkilee.

          • Elizabeth A

            Yes it sure as hell is. That’s why we should be encouraging individuals to use their best judgment about how to handle their personal situations, and not advising one size fits all “solutions”.

          • Charybdis

            Skin to skin raises blood sugar? Damn, maybe diabetics should know about that little nugget of information./snark

          • Heidi

            Yeah, my baby spent hours skin to skin and hours suckling at my breast. Never brought his blood sugar up. 20mL of Similac did, though.

          • Nick Sanders

            Formula fed babies are sicker, more likely to be hospitalized.

            First, prove that. Then, show it’s actually caused by the formula, rather than a confounding variable. Just off the top of my head, formula use is more common among those with lower incomes, and lower incomes are directly and indirectly linked to poorer health in a variety ways.

            3 of the top 5 reasons the US spends money on sick children come from conditions that would be reduced in number if babies were breastfed according to recommended guidelines.

            Prove it would reduce their incidence.

          • Elizabeth A

            Children with working parents are both more likely to be formula fed and more likely to attend day care.

            Children in daycare are far more likely to develop illnesses and be hospitalized for them than children who aren’t.

          • Irène Delse

            A big “Citation needed”! You assert that formula causes harm, but what do you offer as justification? More groundless assertions. That’s not good.

          • Megan

            1. Citation needed that skin to skin contact increases blood sugar in babies. I call BS.
            2. Women with term infants are very unlikely to have access to donor milk as there is not enough of a supply to give to all who need supplement and it is (and should be) given to preterm babies first, who have actually been shown to have measurable benefits from it.
            3. Formula feeding was INFINITELY easier for me than breastfeeding and I’m sure many others feel the same way. Do those of us who don’t meet your narrative just not count?
            4. More parents stay home from work with sick children because we do not have paid maternity leave and women return to work very early, sending kids to childcare/daycare where they are EXPOSED to more illness than they would be at home. Does your cited study account for children exposed to illness through childcare or an older sibling?

          • AllieFoyle

            Also, personally I would prefer my infant receive formula over donated human milk, and I don’t really appreciate someone else deciding that the benefit of a small amount of breastmilk is worth exposing my infant to the risks of communicable disease.

          • nikkilee

            1. go through this bibliography to find citations relating to blood sugar. http://www.skintoskincontact.com/susan-ludington.aspx

            2. Many women are turning to informal sharing networks that CAN be safe sources of human milk for term infants. http://www.ncbi.nlm.nih.gov/pubmed/25333804

            3. I work with mothers who feed formula all the time; everyone has their own narrative.

            4. Babies who get mother’s milk at daycare are less likely to get sick.

            a) Daycare attendance, breastfeeding, and the development of type 1 diabetes: the diabetes autoimmunity study in the young. Hall et al:
            Biomed Res Int. Epub 2015 Mar 25

            b) Babies in daycare have twice the chance of needing antibiotics. Receiving human milk for at least 4 months decreases that chance.

            Protective effect of human milk on children in daycare lasts into the second year of life.
            Dubois, Social Science and Medicine 2004

          • Megan

            Can’t look at your citations since it’s a link to someone’s bibliography and not the actual studies (and I’m not at work where I have access anyway) but even the titles all clearly say that those are studies of kangaroo care and blood glucose in premies. They say that premies receiving KC have the same or higher glucose levels than controls. That is not the same as saying that skin to skin contact increases blood glucose (and even if it did, wouldn’t necessarily apply to term infants).

          • FEDUP MD

            Huh? How on earth could skin to skin CREATE something from nothing? The reason newborns have low blood sugar is usually due to lack of intake from poor feeding combined with lack of stores of glycogen,immature liver etc. sometimes combined with hyperinsulinemia. Glucose doesn’t magically waft in from the air. It has to come from somewhere. It is a basic physical property, law of physics. Perhaps if you understood the metabolic pathways in humans in detail, which have been known for many years, then this claim would also be perplexing to you.

          • Who?

            Pick me to answer for nikkilee. Skin to skin just does, okay??? Once day scientists will work out why and then naysayers and disbelievers like you and I will be smiling on the other side of our skeptical faces.

            Or something.

            I think we both know that nikkilee doesn’t believe in metabolic pathways, though they are known to science.

          • guest

            A hundred bucks she (or her bogus citation) has mixed up the “skin to skin raises the neonate’s temperature” with “skin to skin raises the neonate’s blood sugar.”

          • nikkilee

            All babies experience a drop in blood sugar once the cord is cut. Term infants keep warm from their brown fat stores; it seems that this drop in blood sugar (at its nadir about 1-2 hours after birth) triggers the baby’s metabolism to kick in and start regulating for itself. If a baby’s blood sugar is measured 1 hour after birth, the result is guaranteed to be low; this is part of the baby’s metabolic transition.

            Skin to skin keeps babies calm and warm. A cold or stressed baby will burn up its blood sugar; so keeping calm maintains its blood sugar.

             ”Initiation and establishment of breastfeeding, and reduction of hypoglycemia risk, are facilitated by skin-to-skin contact between the mother and her infant immediately after birth for at least the first hour of life and continuing as much as possible. Such practices will maintain normal infant body temperature and reduce energy expenditure (thus enabling maintenance of normal blood glucose) while stimulating suckling and milk production.31,41 (II-2, III)”
            http://online.liebertpub.com/doi/full/10.1089/bfm.2014.9986

          • Azuran

            So basically that means: Keep the baby warm.
            Which is really one of the basic thing of baby care.
            Skin to skin does not have any kind of better property. Just keeping the baby warm in any kind of way should have the same effect.

          • fiftyfifty1

            “Just keeping the baby warm in any kind of way”

            You know like hatting….but many lactivists oppose hatting. Strange that.

          • fiftyfifty1

            Oh Nikkilee, do you even read your own research links (weak as they are)?

            Term newborns without any risk factors are unlikely to develop clinically important hypoglycemia in the first few hours, and therefore if a low-risk term infant is not displaying any signs of hypoglycemia, there is no need to go testing for it. Duh. This has always been hospital policy. But if an infant DOES have risk factors (e.g. macrosomia, low birth weight, diabetic pregnancy, long or infected labor etc), or if it shows clinical signs consistent with hypoglycemia, then the hypoglycemia should be tested for, and treated. Mild,transient hypoglycemia is unlikely to cause permanent brain damage, but prolonged hypoglycemia does, so hypoglycemia needs to be treated. And skin-to-skin is no treatment at all. It’s true that skin-to-skin can help a baby stay warm (just like hats, warm blankets and warmers can), and that a baby will burn more calories if it is left improperly dressed in a cold room (duh). But that doesn’t mean that warming a cold baby will, of itself, treat hypoglycemia.

          • Megan

            Must be difficult for nikkilee, trying to make science say what she wants it to.

          • fiftyfifty1

            “Must be difficult for nikkilee…”

            Naw, it’s probably easy for her most of the time. What could be easier than to bully scared, exhausted postpartum moms by citing some bogus uncontrolled retrospective breastfeeding studies that they don’t even have access to? What could be easier than to live life secure in the knowledge that the humiliation you secretly love dishing out is really all for their own good.

          • nikkilee

            Hospital policy is determined by the experience and views of the physician in charge of the newborn nursery. That determines whose blood sugar is tested and when.

            The protocol I gave is not used in common practice.

            There are hospitals in my area that will send a term newborn to the NICU if the blood sugar is below a certain number. What the evidence says, and what physicians do are two different things. Of course, if there are risk factors, and a baby is symptomatic, the baby needs to be fed. (Feeding should be with human milk if that’s the mother’s goal.) Any concerns about blood sugar warrant a baby to be put skin to skin, and continue monitoring.

          • fiftyfifty1

            “There are hospitals in my area that will send a term newborn to the NICU if the blood sugar is below a certain number”

            But tell the whole story please Nikkilee. Don’t lie by omission. These weren’t healthy, low-rsik, asymptomatic term babies now, were they? No, these were babies that had other known risk factors for the sort of prolonged hypoglycemia that can lead to brain damage. You know, like macrosomia, low birthweight, diabetic pregnancies, chorio. Nobody is testing low-risk, full term infants who are displaying no signs of hypoglycemia, and you know it.

            Any concerns about blood sugar warrant TESTING (not hiding your head in the sand) and if found to be low, then treatment which can include either breastmilk (if available, which it often is not if mom is not yet producing much) OR formula, which is a wonderful, safe choice proven to bring up glucose out of the danger zone. In addition, baby should be kept appropriately warm of course, but that can involve a hat and warmer, it doesn’t need to be skin-to-skin.

          • nikkilee

            Actually not, fiftyfifty1. These are healthy term babies whose have a blood sugar below a certain number. That’s what has nurses and families so upset. Plenty of low-risk, full-term infants have their blood sugar tested.

            I have both seen this in hospitals where I have worked, and I am still hearing it from nurses (who are upset at having to stick babies every half hour until the physician feels better) and from families who are separated from their newborns and traumatized by the energy of this situation.

            That’s why the ABM protocol is so specific, because clinical practice has to change.

            One of the problems is that some term newborn nurseries are headed by neonatologists, who are skilled in the care of premature or sick babies, but know little about healthy term ones. Neonatologists like these test every baby, panic at a low number and react.

          • Monkey Professor for a Head

            Neonatologists don’t know anything about healthy term babies? Because they don’t train in general paediatrics before specialising in neonatology?

            This just reminds me of the people who claim that obstetricians go through their training without ever seeing a vaginal birth.

          • nikkilee

            Call it what you want, I am merely reporting on the stories I hear from nursing and lactation staff at many hospitals.

          • fiftyfifty1

            “Call it what you want”

            I’ll call it what it is: “something nikkilee made up”.

          • StephanieA

            I’m calling BS as well. Healthy, term newborns are not tested for hypoglycemia. I haven’t seen it happen EVER in the three hospitals I’ve worked at in my area.

          • Who?

            Surely if their blood sugar is low, by definition, they are not ‘healthy’? Let’s see, a few hours in the nicu and a bottle v holding skin to skin while child sucks empty breasts, sticking it with needles to be sure the sugar isn’t going the wrong direction, and then going to the nicu and giving the bottle anyway.

            I know which I’d choose. Funny how when your positions disagree with those of professionals with vastly more knowledge than you, it is always them, not you, that needs more educating.

            And I’ve got out my homebirth bingo card-you’ve already done ‘it’s mama’s choice, don’t blame me when you take my advice’ and now we have ‘can’t trust people who know all about things going wrong, only people who know about wellness’.

          • nikkilee

            Everybody’s blood sugar gets low as part of being hungry. ..

          • Nick Sanders

            Comparing a hunger dip to hypoglycemia is like comparing a pothole to a ditch.

          • Bombshellrisa

            You are an incredibly empathetic person. I would eat biscuits and gravy with you anytime!

          • demodocus

            i dunno, some of the “potholes” around here…

          • fiftyfifty1

            “Everybody’s blood sugar gets low as part of being hungry. ..”

            Ha ha ha ha ha ha ha! You don’t know the first thing about normal physiology do you? Hypoglycemia when you are hungry is never normal. Even people starving to death usually have blood sugars in the normal range. Look up gluconeogenesis.

          • FEDUP MD

            No, they don’t. Nonnewborns without metabolic disorders have various stores of energy which allow them to go many many hours without food without any issues, and to keep a completely normal blood glucose level during that time. Yes, even when hungry. No healthy child or adult will ever get a blood glucose level low enough to seize. This is NOT the case in newborns. Those of us who have worked with more than just newborns can tell you that. The ONLY patients I have ever seen seize from hypoglycemia are 1) people with inherited metabolic disorders (mitochondrial, fatty acid oxidation defects, etc) 2) people with diabetes with insulin dependence 3) newborns who didn’t eat. That’s it.

          • fiftyfifty1

            You are telling me that you work at a hospital where term babies without any risk factors for hypoglycemia and without any signs consistent with hypoglycemia get tested anyway. I call total bullshit on this.

            ETA: And your claim that neonatologists “know little about healthy term [babies]” would be laughable if it weren’t just a variation on the tired old “obstetricians have never seen a normal vaginal birth” lie. Neonatologists are all fully trained general pediatricians first, and you know it.

          • Who?

            Seriously, if you had your homebirth bingo card out now, as I do, it would be filling fast.

            ‘It’s all mama’s choice’ (so don’t blame me); doctors only know about the abnormal; if you believe enough you can do it.

          • nikkilee

            I don’t work in hospitals as a nurse any more. I am merely reporting about the questions nurses ask me and the situation that they report.

          • fiftyfifty1

            In other words you are passing along unfounded claims without knowing key facts.

          • The Bofa on the Sofa

            It’s called, “Making shit up”

          • Dr Kitty

            Really?

            I love the complete lack of self awareness and arrogance of this post.

            That you know better than board certified neonatologists whether a low blood glucose reading can be safely ignored, and WON’T lead to hypoglycaemic seizures and brain damage is just…well, Dunning Kruger in action.

            Who the hell should head a hospital newborn nursery if not a doctor specialised in the care of sick neonates?
            After all, all the well babies are rooming in, so it should only be sick babies IN the nursery.

            Out of curiosity, what is the lowest blood glucose reading ARE you sure it is safe to ignore?

          • nikkilee

            Here’s what the doctors writing the hypoglycemia protocol have to say about it:

            http://online.liebertpub.com/doi/full/10.1089/bfm.2014.9986

            “The definition of hypoglycemia in the newborn infant has remained controversial because of a lack of significant correlation among plasma glucose concentration, clinical signs, and long-term sequelae.”

            “No studies have shown that treating transiently low blood glucose levels results in better short-term or long-term outcomes compared with no treatment, and in fact there is no evidence at all that hypoglycemic infants with no clinical signs benefit from treatment.11,12”

            Experience shapes perception and vision. If I based my view of breastfeeding only on my clinical practice, I would be a different practitioner than I am today, who has had years of experience with the wide range of health and normal breastfeeding.

          • Irène Delse

            “Until the physician feels better”? Talk about demonising doctors! Say rather “when the baby is not hypoglycemic any more”.

            It’s difficult to take you seriously when you assert without evidence that doctors submit healthy newborns with no symptoms and no risk factors to unnecessary blood tests, and then push a NICU stay and formula regardless. Are you telling us that there is a cabal of evil MDs bent on sabotaging breastfeeding at all costs? Or isn’t it more likely that you don’t realise that those newborns did have risk factors, that their hypoglycaemia was real and not too be taken lightly, and that if mom didn’t have enough milk yet, a few cc of formula can be just what’s necessary to take the baby out of a downward spiral.

          • The Computer Ate My Nym

            One of the problems is that some term newborn nurseries are headed by neonatologists

            Yeah, that’s a problem all right. Having doctors who specialize in the treatment of children and especially babies run a nursery: what were they thinking?

            Neonatology is a subspecialty of pediatrics. Neonatologists are very well informed in the care of normal newborns. Unlike, say, DEMs.

          • Bombshellrisa

            Is there a well baby nursery, or is the NICU the only option for a baby who needs more care than couplet care?

          • nikkilee

            Most hospitals have a well baby nursery.

          • Bombshellrisa

            I live where there are 16 hospitals in the area, all do maternity but none have well baby nurseries.
            The reason I asked about the particular hospital is that we are seeing more rooming in, well baby nurseries gone, so a baby who isn’t well enough to be cared for in couplet care but wouldn’t necessarily be NICU care is sent to the only place that a nurse can focus on them-the NICU. So it seems like overkill and in a way it is. But with the focus on rooming in, the BFHI has made it rooming in or NICU.

          • FEDUP MD

            That is not what you said. You said skin to skin RAISES blood sugar. This is not raising blood sugar. This is preventing hypothermia, which, incidentally , can also be done by a warmer if mother or baby is ill and can’t do skin to skin. Yes, we have known since the caveman days that babies can’t regulate their temperature well and are prone to hypothermia and that it is not good for them, in fact, you will note a row of isolettes and warmers in any maternity ward for that very reason. When my father was born prematurely at home during WW2 and thought too small to survive they put him in a box under the wood stove. I am waiting to see where it RAISES blood sugar as you said, i.e., in the not insignificant portion of babies who already do have low blood sugar according to standardized norms. Yes, we all know newborn babies have much lower blood sugars than older babies, you will note there are published norms which take this into account. What I am looking for is how precisely how glucose can be magically elevated by skin to skin. What you are saying instead is that hypothermia is bad, which we all know, and can cause a host of issues, which we know, and that not feeding the baby causes low blood sugar, which we know.

          • nikkilee

            I was wrong. . . thanks for correcting my thinking.

          • Who?

            Who knows whether your thinking has been corrected-your confident and incorrect assertion has been.

            Will you stop making that assertion in future? Or will it remain in your repertoire?

          • CharlotteB

            You know, for his first year, my kid has never needed antibiotics, never had an ear infection and barely had as much as a stuffy nose. Probably because I breast fed, right?

            OR, could it POSSIBLY be that it was because I basically never left the house? (anxiety+ feeding all the time means you don’t go anywhere).

            I actually combo-fed for most of his first year. When people would imply that my supply would suffer because of formula, they had it backwards. My low supply caused me to need to use formula.

            Suplementing worked wayyyyy better for my son than wearing him in a sling and giving him a pacifier, as the LC suggested I do, rather than give him “fast food” in the form of formula. Oh she double-counted one of his diapers too, because it “felt heavy.” Conviently, that brought his count up to minimum.

            To quote my husband, after I went to the LC when it was clear our son wasn’t gaining enough weight: “wait. She told you NOT to feed the baby??” Yep. Yep she did.

            But YAY, no antibiotics for that first year, right?

          • nikkilee

            No wonder folks are furious. . . so many on this list have stories where the LC has been less than helpful. I wish I had been the one to see you.

          • Bombshellrisa

            My LC was fabulous. Professional and supportive. She was also realistic and told me that putting baby to the breast, then feeding him formula/pumped breastmilk, then pumping would be my schedule every three hours until my son could latch. She told me that is a hard schedule to keep up. I had 39 minutes between cycles there and it’s not enough time to rest well or do much beyond take a shower and grab a quick snack. The LC helped me realize that it might not work to breastfeed and that feeding the baby was the most important thing. If you are the type of LC who talks to women like that, encourages them to look at the big picture and to be realistic, then cool. I would see you.

          • guest

            DEAR GOG NO. You are at the very bottom of the list of LCs I would ever wish on someone seeking help.

          • CharlotteB

            So if a mom comes to see you because baby isn’t gaining enough weight and the pediatrician said to supplement, what DO you tell her?

            Do you show her how to make a bottle, discuss how to choose formula, how to store it? Do you ask her what her goal is–working toward EBF, combo-feeding, or switching to formula?

            Or do you assume she wants to EBF, drone on and on about latch (which is fine), demonstrate the Breast sandwich (over and over and over) and tell her that it’s ok if baby nurses 24/7 and that it’s totally fine if baby gains weight slower than what the pediatrician said was acceptable??

          • nikkilee

            Start by asking her what her goals are. Base the recommendations on that. She might need to bottle-feed formula for a few days to catch up on her sleep. She might be sick of pumping and be happier with a tube feeding device at breast, through which formula could be given. She might be hating breastfeeding and want to quit but her baby’s father might be pressuring her to continue; in that case, I’ve advocated for the mother. She might want to go for 100% exclusive breastfeeding. Depends on baby’s age and what is happening. Depends on lots of things. There’s too much to evaluate to answer in detail here.

          • Azuran

            My older brother had a lot of colics as a baby and went to the emergency room for otitis at least 4 times/year in the first 7 years of his life. 100% breastfeed for over 6 months. So yea…

          • Elizabeth A

            That blood sugar bibilography is not doing as much to support your case as you might hope. The articles purporting to show that kangaroo care/skin to skin infants have higher blood sugar mostly discusses blood sugars at as much as 90 minutes post-birth (one study has a follow-up at 24 hours). This is not the stage at which doctors begin suggesting formula.

          • Bombshellrisa

            Maybe that is what is what makes some families choose formula, that “anyone can do it”. Babies don’t care who is feeding them, although I have found that being able to give a baby a bottle is a source of joy to auntie, uncle, grandparents, godparents, ect. Not to mention it meant that my husband was able to alternate nights with me, so I got to sleep, be refreshed and that makes me a better wife, better mother and able to actually function. Much better than it was for me being the only one to be able to feed an infant and never being able to be by myself or leave her with anyone.

          • The Computer Ate My Nym

            By what possible mechanism of action would skin contact raise blood sugar? Even if you hypothesize some vague hormonal effect, do you want to wait for that to take effect in a baby that is hypoglycemic?
            And I am completely uninterested in giving my baby a filtrate of blood from a stranger when there is a perfectly good alternative that has no risk of infection associated with it.
            I also note that you addressed my analysis of the linked article not at all.

          • guest

            Presumably the same mechanism that causes amber teething beads to work (i.e., no mechanism, because it’s physically impossible for these things to do that).

          • Gatita

            There’s nowhere near enough donor milk available to supplement all babies who need it. There’s not even enough to feed the preemies who really do benefit from breastmilk. And jaundice is not something to fuck around with in a newborn. Kernicterus can cause mental retardation and deafness, among other things. Oh and it can kill the baby too. I’d much rather supplement too many babies (which is a low risk intervention) than risk death and permanent severe disability.

          • DelphiniumFalcon

            Riiiight. Because neonatal bilirubin levels for newborns totally isn’t a priority to monitor. I guess I should go tell the lab at work that we can stop labeling them “STAT” and stop basically giving these babies a fast pass to the lab to get this monitored. A lactation consultant told me they’ll be just fine!

          • AllieFoyle

            Healthcare professionals “don’t understand or are ignorant” of breastfeeding or they just aren’t 100% believers in the breastfeeding uber alles philosophy? I find it very, very, very hard to believe that any maternity/pediatric healthcare worker today hasn’t heard the party line on breastfeeding many, many times.

          • nikkilee

            I have 6 years of education as a nurse; breastfeeding was never mentioned nor taught. Unfortunately, this is more common than not in medical, nutrition, and nursing schools. http://healthland.time.com/2013/01/02/is-the-medical-community-failing-breastfeeding-moms/

          • Bombshellrisa

            Didn’t you say you started your nursing career a long time ago? Education for nursing is different now.

          • nikkilee

            I teach hundreds of nurses a year; most haven’t had any education about breastfeeding, even recent graduates. More do than when I was a student, and it is far from enough.

          • Who?

            The fact that someone who thinks low blood sugar and jaundice are no big deal is teaching nurses is horrifying.

          • AllieFoyle

            Or that you can fix low blood sugar with skin to skin contact…. Some kind of special BFHI magic where glucose molecules can be transferred through skin by passive diffusion or something. It’s a little disturbing if she actually believes that.

          • Bombshellrisa

            Far from enough to do what? To what end? Breastfeeding is a way to feed a baby. It’s nice to have someone who helps with things like latch and position, but it’s not like you can actually change people’s life circumstances so that breastfeeding will work. The evidence you are trying to present to bolster your argument is weak. If someone wants to breastfeed and you can give a few practical suggestions (like laid back nursing, which I found helps so many mothers or nipple shields, which didn’t want to use and then was helped to use by my awesome LC) then cool. But you should not be using arguments like skin to skin helps blood sugar regulate or any of the other things you have mentioned here to manipulated endanger vulnerable women and their babies. I don’t try weak arguments or shaming with my patients and I expect other professionals to do the same.

          • AllieFoyle

            Sorry, your claim is really at odds with my experiences having and raising babies, in which every single medical professional I interacted with promoted breastfeeding ad nauseum, while generally ignoring things that might have been much more meaningful and helpful to my babies’ and my own health.

          • BeatriceC

            It’s at odds with my experience too, and I had babies back when there was still formula samples in the gift bags. Funny thing. That formula in my oldest kid’s gift bag actually saved that breastfeeding relationship, and probably those of his brothers as well. If I hadn’t made it work with the first I probably wouldn’t have even tried with the others.

          • momofone

            What do you teach nurses to do when a mother is not planning to breastfeed?

          • nikkilee

            Baby will still go skin to skin at birth because it is the best place for baby to recover from birth. Teach paced bottle-feeding and cue-based feeding. Switch sides when using the bottle to promote optimal eye development. Ask if pumping and bottle-feeding might be a possibility. Make sure mother has folks to help her when she gets home to avoid shopping, cooking, cleaning and childcare for at least a week. Encourage baby wearing and infant massage.

          • momofone

            “Baby will still go skin to skin….” And if the mother isn’t interested in skin to skin, or baby wearing, or infant massage? How do you make sure she has people to help her? Do you arrange their services?

          • Nick Sanders

            What’s so special about baby wearing and what is “infant massage”?

          • guest

            Do you also teach parents when to STOP paced bottle feeding? Because after the first week or so, paced feeding disrupts the natural rhythm of infant feeding and it should be ceased.

          • Megan

            I graduated from medical school in 2010. We were taught nothing about formula. We were ONLY taught about breastfeeding. It’s not that physicians are ignorant about breastfeeding. It’s that we don’t agree with you that it’s imperative.

            As a family doc, moms matter to me as patients too, as does the rest of the family. They should do whatever makes them all happy and helps them cope the best with having a new baby. Sometimes that’s breastfeeding. Sometimes it’s not. We should support breastfeeding and I do, but there’s no good reason to shove it down everyone’s throats.

          • fiftyfifty1

            I’m a family physician who graduated a decade or so in front of you. Same story: we were taught nothing about formula, only taught about breastfeeding. And the lectures from lactation consultants were filled with a lot of woo.

          • BeatriceC

            Oh dear Flying Spaghetti Monster. I had inner city 7th graders parroting the breast is best party line. You have to be living under a rock to have been spared getting hit over the head with that particular message.

          • Bombshellrisa

            The formula can says breast is best and there is a line you can call that is answered by LCs that the formula company employs.

          • demodocus

            We got free samples in the mail (not sure how?) and in among the 3 small cannisters was a little booklet with all their fancy variations, and 9 or 10 pages dedicated to how to breastfeed.

          • Bombshellrisa

            Yeah, how do we get those free samples? We got two brands. It was a god send. I got that same booklet, it was hilarious to me.

          • guest

            It’s in your face riding the spaghetti-damned subway in NYC, the smug little “best is best” with misleading information about the benefits. EVERYONE knows by now.

          • nikkilee

            It’s a useless phrase, and is on formula cans.

          • Irène Delse

            I can believe they didn’t teach breastfeeding in a realistic way. After all, that would imply teaching about breastfeeding failures due to anatomical and physiological issues, and also teaching the ethics of lactation advocacy, ie respecting the autonomy and dignity of people with milk-producing breasts.

            That they didn’t mention breastfeeding at all… Sorry, that must be a quirk of your memory.

          • Charybdis

            In my neck of the woods, there is a public service announcement/commercial that portrays a woman going to work, pump in tow, and pumping several times, smiling the entire time, leaving work and going home to husband and baby at 5:00 on the dot.
            The gist of the message is that breastfeeding moms are happier employees, more productive employees and better all-around people, because, you know, Breast Is Best!!!!!

            It’s gag-inducing.

          • nikkilee

            The mother who is pumping at work is working two jobs.

          • Elizabeth A

            And can only bill for one of them.

            Pumping cost me $130/week. And people keep telling me that formula is expensive.

          • nikkilee

            Please tell me how pumping cost so much. Thanks.

          • Box of Salt

            nikkilee “Please tell me how pumping cost so much”

            Her employer does not pay her for the time spent pumping.

            Why don’t you listen to what women are telling you, instead of assuming your ideas are what’s best for everyone?

          • Nick Sanders

            Well, I’m guessing that they don’t just give away pumps for free.

          • nikkilee

            If the most expensive pump was purchased, it would cost around $1,000. That would be a one-time purchase, whose cost would be amortized over the length of time the mother was pumping, usually 26 to 52 weeks. No way would this work out to $130/week.

            Many insurance companies are now giving pumps to their members. Other mothers spend far less than $1,000 to buy a good pump.

            That is why I am asking.

          • Nick Sanders

            And after that 26 to 52 weeks, you have something you may never use again, nevermind that $1000 is a lot to spend at once. Thus, some people rent.

          • Bombshellrisa

            To the tune of $100 a month to rent. Insurance pays for pumps, but with some plans you have to order the pump at 34 weeks. You have to go through the medical equipment company they contract with and the pump you get might not work for you. I had my baby at 35 weeks, supposedly it takes 4-6 weeks to get the pump to you (I was told this. It might not actually take that long). I ended up engorged and crying and my husband rented a pump at the boutique at the hospital. Breast pads, milk storage bags and nursing bras were not cheap.

          • Irène Delse

            Why do you keep coming up with fantasy scenarios instead of *listening* to what people tell you about their experience? Not everyone will nurse for so long, with or without a pump. Maybe their job makes it inconvenient, or maybe they experience pain and discomfort. Or something else. But you know what? It’s their body. And as Nick already pointed out, paying several hundreds of $ out of pocket for something they’ll likely never use again is not a reasonable option for most families.

          • Megan

            Breastfeeding cost me thousands. Breast pump x 2 (used so much the motor started to go), supplements, illegal domperidone, trips to Albany for frenotomy and then revision (gas, hotel and doctors visits), extra time off work so I could keep working at breastfeeding, nursing tanks, nipple cream, pumping bras x 2, pump parts x 4 sets so I was t always washing them, replacement tubing and valves every 4-6 weeks for my pump, extra doctors visits for weight checks, readmission costs for my daughter for treatment for jaundice/hyperbilirubinia. All in all my estimate for my breastfeeding experience was somewhere between $4000-5000, not including lost wages. And I have insurance that covered most of the cost of my first pump. Even purchasing RTF Alimentum for my new baby for an entire year will cost me less at around $2000-3000, and that’s only if she doesn’t outgrow her dairy allergy by 6 months and doesn’t eat a lot of solids. Bottles were not factored into either estimate because Id need them for breast or formula feeding.

          • An Actual Attorney

            Opportunity costs.

          • Elizabeth A

            I made $26 an hour at the time. One hour of pumping (2, unpaid 30-minute breaks per day). I wasn’t able to make up the lost work time because I dropped my child off at daycare the minute it opened, and had to leave the office in time to pick that child up before daycare closed. I had no weekend childcare available. Work could not be done from home due to security concerns.

            5 hours per work. $130.

          • Box of Salt

            nikkilee “pumping at work is working two jobs”

            Nonsense. She can only do one them at a time.

            nikkilee, have you – yourself – ever used an electric pump to provide bottle milk for your own child, while actively employed at another type of work? Watching TV, surfing the web, or reading a book don’t count.

          • nikkilee

            No, not for my own child. I pumped for a year for a friend who was unable to breastfeed her 2nd child due to inflammatory breast cancer diagnosed at 28 weeks of pregnancy. She was induced at 35 weeks to start chemotherapy.

            After I had my blood tested, to make my friend feel safe about using my milk, her baby got a bottle of my breastmilk every day for the first year. Linda died 11 days before that baby’s first birthday.

            When I say 2 jobs, I mean that the mother has all the responsibilities of her salaried job in addition to all the time and work (unpaid) required to pump.

          • momofone

            I’m so sorry about your friend. That was a huge commitment to help her.

          • nikkilee

            Thank you.

          • Bombshellrisa

            Wonder what my patients would think?
            Me (pumping bra on, pump attached): I have to draw some blood now. I am just going to pump a little while I get this stat cardiac enzymes drawn. Someone else will be in shortly to collect this and run it down to the lab for me. You don’t mind, do you? After all, breast is best”.
            I could pump in the LCs office or break room, but I have to have time to do it. I can take the break, but that leaves patients in the care of other people.

          • Who?

            Well, no. She is engaged in paid employment, and she is also undertaking a time consuming activity that requires special equipment that she perceives has value to her child and herself.

          • LaMont

            They should continue the ad to show how she works on her day job well into the night at home on her computer, while breastfeeding every few hours, while her husband sleeps at a reasonable hour, and then he gets promoted while she gets slowly frozen out and eventually fired for “not being dedicated enough”. For realism!

          • Who?

            You win the internet today.

          • StephanieA

            I’m a nurse. I was taught breastfeeding education in nursing school, as were my nursing friends that went to state schools.

          • Elizabeth A

            There is no mechanism by which skin to skin contact raises blood sugar. Baby has low blood sugar? Let’s offer food! Is really, really logical.

            Baby has jaundice? Jaundice is often cleared by digestive processes! Again, let’s offer food.

            Donor milk is seldom available to babies outside the NICU, and there’s a long process to obtain it. So let’s offer a food that we can get our hands on quickly and easily, right now.

            Formula fed babies are prone to a few more ear infections and diarrheal diseases over the first year of life than breast fed ones. And if you don’t make enough breast milk, a possible hospitalization is preferable to a starving infant.

          • fiftyfifty1

            “Donor milk is seldom available to babies outside the NICU, and there’s a long process to obtain it.”

            Oh, but Nikkilee is fine with informal milk sharing networks, just as long as the milk isn’t sold for money it can be safe and she recommends it over formula.

          • An Actual Attorney

            IIRC, there was a surprising percentage of milk donated to a milk bank (from women who were screened and thought that they were all clear) that had diseases and traces of things that were bad for babies. Does anyone remember that?

          • fiftyfifty1

            I do remember it, although remember it a bit different. It was a voluntary (non-paid) donation, and the women were not pre-screened, but just assumed themselves to be disease free, but it turned out a number were not.

          • An Actual Attorney

            Ah, nursing gave me a chance to Google. I read it here : http://www.skepticalob.com/2012/10/think-peer-to-peer-donated-breastmilk-is-safe-think-again.html

            Dr. Amy discusses the study you mention, but I was thinking of the second study she discussed, Cohen et al.

            Sorry for the bad phone typing.

          • nikkilee

            Yes. . .that’s why donor milk is cultured, pasteurized, and cultured again.

          • An Actual Attorney

            And any informal sharing is so dangerous. That woosh was the point going past you. You can’t tell if someone has a disease by looking at them or “how they live ‘

          • nikkilee

            That’s a decision a mother can make for herself; a major theme here on this list.

          • An Actual Attorney

            Well, it’s a decision that should include father’s, since it’s about what to feed a baby. And they need to be given accurate information, not encouragement of something so dangerous from so called professionals. A 1.6%*chance of exposure to a serious infectious disease is huge. It might even be huge enough that we as a society could decide to ban it. After all, what’s the danger in not being in a car seat?

          • momofone

            True, though another major theme is making decisions based on knowing the risks.

          • Irène Delse

            You confuse “doing whatever I want” with making an informed choice, which is also a major theme here. As an LC, you should be at the forefront informing parents about their choices for feeding their infant. If all you can say to them is, in effect, “breastmilk at all costs”, you’re doing a great disservice to the babies and the parents. So far, we’ve heard from you that formula makes babies sick and lead to obesity (wrong), that unscreened milk from your neighbour or even an Internet stranger is preferable to formula (dangerous advice) and that women who have to work should be happy to pay for a pump and do two jobs at once, only one of them being paid. Color me unimpressed with your contribution to society.

          • Bombshellrisa

            I guess we should be glad she isn’t an oncology or ER nurse. I can tell you she would never fit in with any of the nursing teams I have worked with.

          • Who?

            Classic homebirth hobbyist duck and weave there-‘I’m going to tell you what I think you should do, dressed up as what you should do, then when it doesn’t go well, will tell you that I was only empowering you to make your own choice, not advising you, so it’s your fault.’

            This has the added benefit to the hobbyist of not going down in her personal list of lessons learnt-if such a thing can be imagined-is that since mother made her own decision, it has nothing to do with the hobbyist.

            Shameful.

          • Nick Sanders

            And how many neighborhood sharing networks do that?

          • nikkilee

            Women can pasteurize milk they get from another mother, as described in the 4 Pillars of Milk Sharing from Eats on Feets.

          • momofone

            From the brief read I gave that, I’m having trouble understanding how that would be preferable to formula. I’m also fairly sure I saw a comment yesterday-ish in which you said that bottle feeding breastmilk results in changed composition (which I don’t understand, and may have misunderstood). If that’s the case, what would be the benefit of sharing/pasteurizing milk? (I am all about the pasteurization, but it doesn’t seem consistent with the breastmilk-at-all-costs argument.)

          • Nick Sanders

            You seem to rely very heavily on those “can”s.

          • Bombshellrisa

            Yeah, the “can” and “could”. Anyway it sounds like a lot of work, and I already do a lot of work. I loved going “full lazy” when we switched to formula.

          • Charybdis

            So pasteurizing (heat treating for a period of time to kill bacteria, etc) random donor milk is fine, but heating a breastmilk bottle in the microwave for 10-15 seconds DESTROYS all the speshul breastmilk qualities that make it OMG AMAZING SUPERFOOD!!!

            Right.

          • nikkilee

            Microwaving breastmilk or formula is not recommended. And, breastmilk is an amazing superfood: alive and dynamic, a close cousin to blood. Formula can’t be alive, because it will spoil on the shelf.

          • demodocus

            They don’t recommend microwaving because of potential hotspots. If you’re pastuerizing, you have to heat it way above 97*F. And you were recommending people pastuerize donated milk.

            Neither blood nor milk is alive, it’s part of a living creature and it might have other things living in it, like bacteria and viruses, but it is not alive itself. C’mon, you’re a nurse, you’ve had *way* more biology than I have and I learned this by freshman year of high school.
            Twinkies spoil on the shelf, too, given time. DH once got a box in August and by mid January the 3 remaining twinkies were gray-green.

          • Charybdis

            Breastmilk will also spoil on the shelf; it is not “spoil-proof”.

            I’m saying that if you pasteurize breastmilk, it will no longer have those “OMG Amazing Superfood” qualities people bang on about.

            I find it ironic that the lactivists rant on and on about how formula is possibly the worst thing in the world you can feed a baby (toxic sludge, don’tcha know) but have no problems letting their babies consume breastmilk with blood in it, pus in it if there is mastitis going on, yeast, bacteria, etc and don’t think illness can be spread via breastmilk (HIV, anyone? Anyone? Bueller?), not to mention the fact that the mother’s nipples are not sterile either.

            Double standard much?

          • demodocus

            I think she’s saying only “alive” food spoils. Which is silly.

          • Nick Sanders

            “Superfood” is a meaningless term.

          • Roadstergal

            I use it to refer to food I buy at the supermarket.

          • Irène Delse

            You do realise you’re contradicting yourself, right? Two days ago, you told Nick that donor milk can be pasteurised to avoid infections. Now you warn against using a microwave on breastmilk. So is heat allowable, or is it not?

            BTW, this rambling about “super food” is marketing, not science. According to the marketers, acai and goji berries are “super foods” too, but you’re not going to give them to a newborn.

          • Heidi

            I love making my own kefir and yogurt. You use pasteurized milk. Pasteurized milk no longer has any active cultures in it unless you add them back in. Yes, raw milk does have natural bacteria, even beneficial ones, but very much at the risk of deadly ones because cows and goats have no problem walking through their own feces. The benefit of pasteurizing definitely outweighs the risk of killing bacteria and yeast we might want. Pasteurizing breast milk kills all the bacteria, viruses and fungi off, at least most of them. There are a few bacteria that can withstand high temperatures but I doubt they are to be found in most milk, human or other mammal.

            Anyway, once breast milk is pasteurized, it is more susceptible to harmful bacteria because it has no competition. It would definitely have a shelf life and the claim that breast milk contains beneficial living organisms would no longer hold true. According to my Medela magnet, even my raw breast milk is very perishable.

            I know that one, I have no desire myself to ever use donor milk unpasteurized because I have no control over how well the mom sanitizes her pumping equipment, if she has clean breasts, or what diseases she may have. For all I know, some disease we don’t know about yet exists, like HIV was at one time. But then I really have to question the point of giving my full term infant pasteurized donor milk.

          • The Computer Ate My Nym

            Which means that any immune cells in the milk are dead and the antibodies probably denatured, so the presumptive advantages of breast milk are largely gone. Culturing won’t reveal if the milk has viral infection, including viruses that are heat resistant. Or prion for that matter. Again, why not just use the non-human product instead of what is basically a fraction of human blood?

          • nikkilee

            The only thing that disappears completely in donor milk is the lipases. Everything else is left, although some of the percentages of immunoglobulins are diminished. Compared to the zero amount of immunoglobulins, species specific proteins and other elements in formula, donor milk is still way better.

          • The Computer Ate My Nym

            So you’re admitting that the sterilization is inadequate to destroy at least some viruses? And just how much use are a couple of spare antibodies when the vast majority of human passive antibody transfer is transplacental?

            I can see there being a role for donated breast milk in premies where there’s a real, documented benefit, but in term infants, it just seems like more risk than benefit.

          • nikkilee

            The benefits of donor milk for premature infants don’t suddenly expire when the infant reaches its due date. Pasteurization and sterilization kill bacteria and viruses. Looking at the evidence, it is best for human infants to receive human milk, no matter their age or condition, from the infant perspective. Why else would the formula industry be spending billions of dollars trying to copy it?

          • guest

            Prove it. Because we know that the benefits of breast milk DO expire. That’s why we don’t consume it as adults. So since the benefits are known to expire, on what evidence can you base your claim that the benefits preemies get don’t expire by the time an infant is full-term (and otherwise healthy)?

          • The Computer Ate My Nym

            Viruses are just DNA or RNA with some protein wrapped around it. Antibodies are just protein. How does the heat magically destroy only “bad” proteins?

          • Sarah

            Presumably in the same way breastmilk cures eye infections.

          • Who?

            So are they all things that science can measure, or things you just know about and are waiting for science to find and identify?

            Honestly your nonsense would fill a book. Why anyone in their right mind would go through all this palaver to feed a healthy term baby some random woman’s breastmilk instead of formula completely beats me.

            God knows what they’ll be doing by the time the poor child is at school to give it some supposed edge on its classmates.

          • nikkilee

            Some families have histories of chronic disease (examples: diabetes, IBS, cröhn’s disease), and some mothers will do anything to prevent their babies from getting a drop of formula, a known trigger for susceptible children. Lots of variation in people that leads to different choices.

          • momofone

            “Known trigger” based on what? Citation?

          • nikkilee

            http://www.ncbi.nlm.nih.gov/pubmed/22891485

            http://www.ncbi.nlm.nih.gov/pubmed/7993386

            http://www.ncbi.nlm.nih.gov/pubmed/10389843

            The studies go further back than that.

            What the formula industry is doing is trying to develop a formula that doesn’t trigger diabetes; this is the TRIGR study. https://www.trigr.org/

            From the 2012 AAP Policy (http://pediatrics.aappublications.org/content/129/3/e827.full)

            Inflammatory Bowel Disease

            Breastfeeding is associated with a 31% reduction in the risk of childhood inflammatory bowel disease.32 The protective effect is hypothesized to result from the interaction of the immunomodulating effect of human milk and the underlying genetic susceptibility of the infant. Different patterns of intestinal colonization in breastfed versus commercial infant formula–fed infants may add to the preventive effect of human milk.33

            Diabetes

            Up to a 30% reduction in the incidence of type 1 diabetes mellitus is reported for infants who exclusively breastfed for at least 3 months, thus avoiding exposure to cow milk protein.13,42 It has been postulated that the putative mechanism in the development of type 1 diabetes mellitus is the infant’s exposure to cow milk β-lactoglobulin, which stimulates an immune-mediated process cross-reacting with pancreatic β cells. A reduction of 40% in the incidence of type 2 diabetes mellitus is reported, possibly reflecting the long-term positive effect of breastfeeding on weight control and feeding self-regulation.43

          • momofone

            Are you seriously claiming that “a drop of formula, a known trigger for susceptible children” is the difference between “triggering” some disease process and not?

          • nikkilee

            Maybe not an actual drop, but Balmer and Bullen showed that gut pH in babies fed an ounce a day only during the hospital stay was still more alkaline 6 weeks after discharge than that of the exclusively breastfed babies. It is the mothers who say, “I don’t want my baby to have a drop of formula.” I have met women like this, including the mother who started pumping along with breastfeeding on the first postpartum day. She had allergies, her husband had allergies, the whole family had allergies, so she decided to induce an oversupply to be sure that her baby “never got a drop of formula” when she had to return to work and her baby would go to childcare.

          • momofone

            If not an actual drop, then you may want to adjust your phrasing, because that is exactly what you said.

          • Megan

            But EBF does not prevent allergies. In recent controlled studies it increased risk of allergies. Who told her she was decreasing baby’s risk by EBF? You?

          • nikkilee

            Generally not, with such an allergic family history, this baby’s chances of developing allergies are very high. However, EBF will postpone their development. It’s a lot easier to take care of child with allergies than of a baby.

          • Megan

            Citation needed that EBF delays allergies.

          • momofone

            “However, EBF will postpone their development.”

            You say that very confidently. Though you never addressed the difference between my breastfed son’s one sick visit his first year and my nephew’s (also breastfed) 40 sick visits the first year, EBF most certainly did not postpone the development of multiple allergies, hence his difficulty. He was EBF and still developed severe allergies in early infancy to several foods or ingredients. It was eventually safer for him to have formula than to breastfeed. What you present as immutable fact is not.

          • KeeperOfTheBooks

            But, but, that would suggest that there are other factors at play than BF vs FFing! Madness, I tell you!
            I mean, DD had a little breastmilk ’til she was about 4 months old, and then it was formula excusively. She also has never had a sick-child visit at over 2 years old. Never.
            I’m sure it’s the miniscule amount of breastmilk she received, and not the fact that she didn’t have older siblings in school, stayed at home with me, and so forth. (Believe me, I’m not knocking either school or daycare–it’s that there are simply fewer opportunities for disease transmission when your two-year-old isn’t swapping germs with a dozen other two-year-olds on a daily basis. ;))

          • momofone

            Exactly! Factors other than breastfeeding–perish the thought!

            In my son’s case, maybe breastfeeding made a difference. And/or maybe it was the fact that, like your daughter, he has no older siblings and was home with his dad rather than in places where he would be more exposed to others. (Nephew has older sibling and was in day care, in addition to his mother’s family having incredible allergy history.)

          • Roadstergal

            EBF will postpone their development. Because nikkilee says so.

          • Who?

            All the citation you need, surely?

          • AllieFoyle

            Citation please. I searched pubmed and I’m not seeing an article like that.

          • nikkilee

            http://www.health-e-learning.com/articles/JustOneBottle.pdf

            Extensive bibliography here, including Bullen

          • AllieFoyle

            Is this the citation you’re referencing?

            Bullen CL, Tearle PV, Stewart MG. The effect of humanized milks and supplemented breast feeding on the faecal flora of infants. J Med Microbiol 1977; 10:403-413

            It’s the only one listed there with either Balmer or Bullen that I can see, and it’s from 1977.

          • nikkilee

            Some studies, about drugs or surgical procedures should be current. Other studies, such as ones about gut physiology or newborn behavior that hasn’t changed in centuries, are accurate even if 20 years old.

            We were taught in graduate school that studies older than 5 years weren’t acceptable. This is not true.

          • swbarnes2

            Umm, you read the latest TRIGR press release, right?

            “We now report the outcome of the first study endpoint, which is positivity for at least two diabetes-associated autoantibodies by the age of 6 years. The results show that there was no difference in the appearance of autoantibodies between the two study groups.”

          • nikkilee

            Both groups were fed formula. The goal of the study is to see if hydrolyzed formula induce as much T1D as regular formula. Seems that hydrolyzed is better in this regard. . . seems for the best research you’d compare babies breastfed according to recommendations with babies weaned to one formula with babies weaned to the other.
            https://www.trigr.org/documents/PressRelease_Knip_NEJM2010_PilotDietIntervention.pdf

          • swbarnes2

            The one I quoted from was ten times the size of that Finnish one. You are citing the earlier and smaller study, and ignoring the more recent much larger one, on purpose.

          • Roadstergal

            Citation #1 is an opinion piece in a random little French publication.

            Citation #2 isn’t available online, but the most generous reading of the abstract would indicate that they found some antibodies developed to cow’s milk in kids (most of their work looked to be in pre-teens and young teens), as one would expect, but found no correlation with development of diabetes, and of course this had nothing to do with formula.

            Citation #3 – if you read the paper (you don’t know how to read papers, do you, nikkilee?), it shows that in a very specific subset of babies with one specific risk allele for T1D, a small number of them – some breastfed, some formula fed – developed T1D (numbers too small to say there’s a difference). In the formula-fed babies who didn’t develop T1D, their antibodies showed a toleragenic profile. What I take from that paper is that breastmilk isn’t protective against T1D in babies with that risk allele, and that cow’s milk-based formula isn’t the environmental trigger.

            Nikkilee, why did you link to the old AAP position paper, instead of the most recent one? The link is right there at the top of the page that you linked to! Could it possibly be because the new data we are all throwing at you has gotten to the point where even the AAP can’t ignore it, and they have significantly scaled back on the health benefits you are trumping, down to “Additional research in this area is warranted?”
            http://pediatrics.aappublications.org/content/115/2/496

            Nikkilee, are you really hoping they don’t keep doing this research that shows that the better you control for confounders, the less of a difference breastmilk makes?

          • Irène Delse

            I’d be curious too! Apart from allergy to cow’s milk protein, I don’t see what illness could be “triggered” by formula. And even then, there’s often cross-reaction to human milk protein, as one of my siblings can attest: he was found allergic to all sorts of milk and milk-based formula. In the end he was fed exclusively with a vegetable-based replacement formula until he could start solids.

          • Nick Sanders

            How the hell does formula trigger diabetes?

          • Roadstergal

            Why did you put an umlaut on Crohn’s disease?

          • nikkilee

            Because I’ve seen it spelled that way sometimes.

          • Roadstergal

            Not in any legitimate publication. I know it may seem silly to pull out such a minor drop of inaccuracy amidst the torrent you’re spilling on us, but to up and go out of your way to mis-spell such a simple word…

          • Roadstergal

            Hey, nikkilee. What is an immunoglobulin, what are the different types, what types are and aren’t present in breast milk, and what do they do?

          • Psst, if nikkilee doesn’t answer, can you tell me? I could ask Google, but if you already know the answer, I’d like to know just to know.

          • Irène Delse

            Oh, it was a subject on this very blog not long ago. Nikkilee would do well to dig a little before answering. 😉

          • Roadstergal

            Oh lol, ask an immunologist and get a book…

            So, immunity to disease is a complex and multi-faceted deal. The upper dead layer of the skin itself, as a physical barrier, is technically part of the immune system. 🙂 The system as a whole is composed of a lot of different and varied parts of the body, from tiny molecules to individual cells to systems of cells. This includes the ‘innate’ immune cells that respond to conserved patterns on certain pathogens, and the ‘adaptive’ immune cells, that rearrange their DNA to generate receptors that can recognize a near-infinite range of antigens (antigen = specific bit of a thing an immune cell recognizes, useful word), and then get selected out to not react to ‘self’ (with varying degrees of success, as anyone with lupus or T1D will tell you).

            Immunity to viruses and other intracellular pathogens is mediated primarily by one type of innate cell (NK) and one type of adaptive cell (CD8 T cell) – CD8 T cells have those rearranged receptors on their surface that recognize ‘altered self’ and respond accordingly. Immunity to extracellular pathogens – bacteria, toxins, and the like – is mediated primarily by a complicated dance, with the B-cell (an adaptive immune cell) in a key role. The B-cell receptor starts off fixed to the cell like the T-cell receptor, but when a B-cell is activated, it turns the receptor into an antibody, a protein that sticks to a specific pathogen but is free to circulate throughout the body. This also triggers a mini-bout of extreme evolution, where professional presenting cells make B-cells compete to make receptors that stick better and better to the antigen of interest (by seriously scrambling their DNA – a process called somatic hypermutation). This process – which requires activating the professional presenting cells – results in antibodies that bind _very_ well to the pathogen (referred to as high-affinity).

            When the B-cell turns a receptor into an antibody, it does so by making another DNA reshuffle, sticking an end onto the back of the B-cell receptor that tells the rest of the immune system how to react to it. The first go of the immune response – the B-cells that stick kinda well to the pathogens – make an antibody class called IgM where the individual antibodies don’t stick well, but they make a massive complex of five of them together (pentameric IgM) that makes up in avidity what it lacks in affinity. As the B-cells do their mini-evolution and get really good at recognizing that pathogen, they make a different ‘tail’ for the receptor that makes it a different class of antibody – one that is dictated by the environment around the mini-evolution (including signals that the professional presenting cells make). IgE, for example, is responsible for allergies. IgG (which comes in four subclasses) is the most potent antibody at drawing in the rest of the immune system – particularly innate cells that eat up pathogens (the most common is indeed called a macrophage – greek for ‘big eater’) and proteins in the body that contain and destroy pathogens. IgG circulates in the blood for several weeks to help eliminate the pathogen it was raised against.

            Another subclass is called IgA. This is a secretory Ig that is specifically for mucosal areas – it forms a dimer (doubles up) that wraps itself in a protein that protects it from digestion in the gut. It’s actively transported into all sorts of bodily secretions – mucus, saliva, and yes, breast milk. Like the skin, IgA is mostly a physical barrier. It sticks to pathogens to try to keep them from clawing their way in to the body. It does not activate the rest of the immune system to a substantial extent, so it’s of limited utility. It doesn’t have the potent systemic effects that the IgGs do.

            After you get an immune response where these B-cells do their mini-evolution, you get two branches of specialization. On one hand, you get a burst of antibodies thanks to a branch of the cells that turn into antibody-making factories called plasma blasts and plasma cells. Once the response subsides, the other side of the specialization gives you long-term immunity from three main angles – long-lived plasma cells that retire to immune sites like the bone marrow, and memory T and B cells (CD4 T cells facilitate the activation and survival of B cells) that retire to places like the spleen and lymph nodes, as well as some other parts of the body.

            This is why vaccination works – the ‘adjuvents’ that the anti-vaxxers bitch about are there to make sure that the presenting cells get the immune system up and running to start evolving the good receptors, and to make sure the B cells switch to the right class to be useful. A lot of work goes into this.

            This is also why the bolus of IgG that a kid gets from the placenta is very short-term (a good antibody has a half-life of about two weeks).

            And I hope it’s clear from all of this why it’s ridiculous to think breast milk is a substitute for vaccination in any way. Breast-milk-derived IgA can do some limited amount to keep some pathogens from getting a foothold in the gut, for the limited time they’re present. But getting vaccinated during pregnancy and getting your kid vaccinated on schedule is what will do something substantive for protection. Oh, also making sure they’re fed and not dehydrated. Stress and starvation are VERY bad for the immune system.

          • swbarnes2

            Is two weeks really all the protection that the TDaP in the third trimester gives to the fetus?

          • Roadstergal

            Two-week half life. 🙂 The duration of protection will depend on the amount of antibody initially present, and the amount required for protection…

            And the two-week half life is a rule of thumb for therapeutic antibodies, you can ask an Ob for more detail. But does seem generally in line with the first vaccines being given at two months… (passive antibodies have to clear to a certain extent for vaccines to be maximally effective)

          • Irène Delse

            Awesome!! Thanks for this explanation.

          • Thank you!

          • nikkilee

            Antibodies are also called immunoglobulins. http://www.medscape.com/viewarticle/814970_2

          • Roadstergal

            You identified a synonym, but did not answer my question. Go on – in your own words, what is an immunoglobulin? What are the different types? What’s type is dominant in breast milk, and what does it do?

          • Bombshellrisa

            I know better then to mess with you when it comes to this stuff, you could wipe the floor with me : )

          • Roadstergal

            I’ve been buried in this stuff for decades, so I should have a handle on it! I continue to learn, though. 🙂

          • BeatriceC

            As I joke around with MrC all the time, what’s the difference between a toddler and a scientist? The fragility and expense of their toys. Every scientist I’ve ever known is simply an adult who never outgrew that toddler enthusiasm for experimenting with the world around them to learn new things.

          • DelphiniumFalcon

            Lol very true. I’ve had to explain to my less tech savvy co-workers that the only real difference between them and me is that I’ve pressed ALL the buttons. Yes I borked a few computers in the process but I now know how to bring one back from the brink of death!

          • BeatriceC

            MrC’s PhD is in biophysics but his career has been in pharma, so a lot of biochem as well. Let’s just say that things can get interesting around here. One of these days I’m going to come home to some sort of explosion in my living room caused by him letting the boys conduct experiments.

          • DelphiniumFalcon

            There have been discussions in my house about including a self destruct mechanism. For science!

          • nikkilee

            Nope. I gave you a link that discussed it well, if you want to know, you can search and read.

          • An Actual Attorney

            I believe Roadstergal is trying to teach you using the Socratic method. She knows the answer. See Bofa’s first law. You would learn a lot if you even tried to answer.

          • Charybdis

            Bwahahahahahahahahahaha!!!!! Bwhahahahahahahahahahaha!!!!! Telling Roadstergal to click on your little link and “search and read” about immunoglobulin, *gasp*

            Bwehahahahahahahahahaha!

          • Roadstergal

            Oh, nikkilee. I would laugh at how transparently stupid you are, but I know that you’re bilking vulnerable women who unfortunately don’t know any better, and that’s depressing. If you had any understanding, you could easily put such an explanation out in two minutes max in simple words.

            (Note that I say ‘stupid’ not because you don’t know things – we all have our areas, lawd knows – but because you pretend to be an authority in an area you know zip about, and spout words you think sound good to make you seem like you have half a clue.)

          • Irène Delse

            I had the curiosity to look up “heat deactivation of immunoglobulin”. It’s more than a little decrease, let’s be honest. And anyway, the immunity a baby gets from breast milk is small compared to that given by vaccines. All reasons for leaving donated milk to preemies, where it really counts.

          • Heidi

            If it’s not available, it’s not better. There’s not enough donor milk for NICU babies, who definitely have priority over healthy, full-term babies. How you gonna go about convincing women to pump for other people’s infants? I mean, first, you can only use women who have an oversupply. I don’t think most women have an oversupply. On top of that, the women who do have an oversupply many times find it a burden. If it’s donated, that woman is providing it for free. How many women out there with an oversupply have the time to pump milk for someone else’s kid? How do we decide which women get to use donor milk? Do we send lactation consultants to her house everyday to attempt to get her supply up, make her take drugs that have serious health consequences, force her to pump and nurse even if she hates it, it traumatizes her, it hurts her physically, just to see if she really is one of the 5-15% (and possibly even a higher percentage than that) women who don’t have an adequate supply regardless of interventions?

            I think most women don’t find pumping enjoyable. Some of us find providing our baby with our own milk enjoyable. I like being able to give my baby 8 oz. of my milk daily, but when he’s on cow’s milk at a year old, I am throwing that pump in the trash. I am not tying myself down to donate milk to healthy, full-term infants. They can drink formula like my healthy, happy baby!

          • nikkilee

            The milk in milk banks comes from volunteers, often as you say, women with oversupply. Some women enjoy donating and feel proud of it. Others would never bother. It is a matter of choice and desire. Here’s an example. http://www.today.com/kindness/woman-donates-92-gallons-breast-milk-stillborn-sons-honor-t59821

          • fiftyfifty1

            “3 of the top 5 reasons the US spends money on sick children come from conditions that would be reduced in number if babies were breastfed according to recommended guidelines.”

            3 out of 5? How do you figure?

          • The Computer Ate My Nym

            Skin contact leads to increased glucose? Um…on what evidence? Even assuming it’s true, does it raise glucose as much and as quickly as is needed to minimize damage to a hypoglycemic baby. I mean, adrenalin raises blood sugar in adults, but I wouldn’t suggest jumping out and saying “boo” to a diabetic going hypoglycemic. (Have I said this before? I feel like I have…)

          • Sarah

            Why on earth would putting a baby skin to skin with mother to raise blood sugars be standard practice?

            As for the rest, to have any idea whether breastfeeding would reduce the money spent on sick children in the US, you’d need to be able to control for confounders much better than we can now. But it would be very inconvenient to acknowledge the role poverty plays in poor health, because then you have to do something about it. Much easier to place the blame on poorer women for not emulating the behaviours of rich women. Costs less.

          • moto_librarian

            How many times does it have to be said before you will finally understand – if a woman goes back to work, she is probably formula feeding AND her baby is in daycare. The babies who are breastfed at my sons’ daycare get the same illnesses going around at the same rate. Studies are notoriously poor at correcting for this huge confounder.

          • Irène Delse

            “Somehow”. Aka, pulling stuff out of your nether regions.

            And you know, individuals do add up to make populations. Like that study who followed only first time mothers who intended to exclusively breastfeed: meaning they had high expectations but zero experience. Including no idea if they would have supply trouble, painful nipples, baby not sucking efficiently… In other words, this population had a built-in failure rate. Surprise! Some of them failed and the failure was attributed to formula being available in the hospital! Had formula not been available those baby would probably have suffered dehydration and hunger until they were discharged… or maybe, longer, depending on how hard the families had fallen for the magic EBF mantra.

            To;dr: not every woman can breastfeed, and this study is very disingenuous.

          • guest

            The things that come out of your nether regions should under no circumstances be used as infant food!

          • AllieFoyle

            But looking at the individual level is important. Plenty of women just do not want to do it, or find that they don’t enjoy it. Are those population-level barriers or individual decisions that deserve respect and appreciation from researchers and policy-makers? Even conceptualizing it is a goal that is being impeded by barriers overlooks the fact that not breastfeeding is often a rational choice based on individual values and circumstances. When you start working toward “removing barriers” in this situation, it starts to look an awful lot like not respecting women’s autonomy.

          • nikkilee

            Human milk is the best food for human infants. All the benefits to a premature infant in a NICU are still there for term infants. Industry marketing has led generations to believe that formula is just as good. Education is a big part of public health policy. And more women are breastfeeding now than 10 years ago, and for longer.

          • Heidi

            Human milk is the best food if baby can nurse, mom makes enough milk, mom has the time and energy to breastfeed, and if mom enjoys breastfeeding. Heck, I found breastfeeding almost impossible just because of the shape of my breasts. Then I still didn’t make enough. Formula sometimes is the best option.

          • Megan

            “Formula sometimes is the best option.”

            Definitely preferable to hypernatremic dehydration, kernicterus and starvation. But you know, moms who don’t make enough milk don’t exists according to nikkilee. Guess I’m not real.

            If we take her example of 4 million babies being born, 5% of that is 200,000 moms who won’t make milk. Guess those babies don’t matter. Never mind that the 5% number is probably not even correct and a study cited by the ABM showed 44% of primips with delayed lactogenesis II (whose babies should be supplemented). But according to nikkilee, giving formula in the first few days just “creates challenges.”

          • Bombshellrisa

            No, she is implying that it’s most important for a mom to love a baby, and that means someone will breastfeed. You can’t love your kids if you are merely attentive to their needs, go back to work so you can provide things like food, shelter and college funds and want to focus on the big picture of parenting. Nah, you have to breastfeed, that is real love!

          • demodocus

            5%, otherwise known as about 1 kid in every kindergarden class. Yep.

          • guest

            And throw in some mothers of multiples, too – I don’t think they’re counted in that 5%. But while some women can produce enough for twins or triplets, many who could easily feed a singleton can’t produce enough for more. Those babies ought to matter too.

          • StephanieA

            This infuriates me. I would never make my toddler wait 5 days to eat, why in the world are we doing this to newborns? Who gives a crap if formula feeding ‘creates problems’ when a starving baby is the alternative?

          • Irène Delse

            Way of missing the point. You can say “human milk is best” all day long, but you are not acknowledging that women are human beings with rights of their own. One of those right, very basically, is the right to make decisions over their own body. You may wish all mothers could breastfeed, but ultimately, it’s their call, not yours. Devising a policy that pressures women into breastfeeding is not doing what’s best for babies, it’s disrespecting both women and babies. Because in the end, the stress of forced rooming in and patronising “breast is best” lectures take its toll on both mother and infant. Plus there’s the starving that so often happens in the hospital.

          • BeatriceC

            Or we could just invoke Bofa’s second law.

          • Bombshellrisa

            Yeah, that is easier. But it requires critical thinking skills that are sadly lacking in lactivists.

          • Megan

            Actually good quality recent research on breastfeeding has “led me to believe” that formula is very nearly as good in term infants when there is access to clean water. Only real difference is a few colds and GI bugs, across the population, as you’re so fond of saying.

          • nikkilee

            How about this? Breastfeeding is good for mothers’ health also.

            http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/

          • momofone

            Can be good. May reduce risk of certain things. Which by definition also means may not. For some people the reduction in risk may not be worth what it takes to breastfeed, and for some people it may be worth it and not reduce their risk enough (that would be me).

          • AllieFoyle

            It is associated with some positive outcomes, but again you have the correlation vs. causation problem. You also have adult women who can probably best decide for themselves how best to weigh potential small health benefits with the very real costs of breastfeeding for themselves, which, like health risks, will vary from woman to woman.

          • momofone

            You said that so much better than I did.

          • Megan

            Wasn’t good for my health. I gained weight breastfeeding (25 lbs in fact; made me fatter than being pregnant), couldn’t take my regular medication, was depressed and never spent any time with my child, only my pump. I’m so much healthier when I FF; lost all my pregnancy weight plus extra by 2 weeks PP, can take my regular meds, get to hang out with my family instead if my breast pump and no depression once my milk dried up.

            As for your citation, it’s simply a review article by Alison Steube based on the same kind of weak studies you cite. Trash in, trash out.

          • The Computer Ate My Nym

            That citation is 7 years old and somewhat out of date. For example, later research has found an increase in triple negative breast cancers among Hispanic women who breastfeed*. A lot of the infant benefits appear to have evaporated when confounders were properly controlled for as well. Even in the review you cite, a lot of the confidence intervals are hugging one at the lower end and few show relative risks of greater than 2. I’d say the benefits, if real, are minor and while encouraging breast feeding is reasonable, it should not be encouraged at the cost of ignoring other dangers, such as hypernatremia from dehydration.

            *Heh. Now they tell me.

          • AllieFoyle

            And having happy, healthy, well-rested parents and a safe, enriching environment with plenty of love and financial stability is best for human infants too. Breast milk’s benefits for term infants pale in comparison to the effects of good parental mental health and high SES. The benefit of exclusive, long term BF over combination feeding or short term BF is negligible.

          • nikkilee

            The research doesn’t support your last sentence.

          • AllieFoyle

            Then by all means, please share some citations to studies that show that exclusive, long term breastfeeding confers significant advantages over combo-feeding or BF for shorter periods.

          • Who?

            Apart from a complexion nikkilee can sometimes spot as breastfed, do you mean?

          • guest

            NO. WRONG. The benefits of breastmilk for a preemie ARE NOT THE SAME as for a term infant. Term infants aren’t susceptible to NEC. NEC is the biggest reason preemies benefit from breastmilk (otherwise they are often better off on a special calorie-enriched formula, depending on how close to term they are).

          • nikkilee

            “Term infants develop necrotizing enterocolitis much earlier, with the average age of onset within the first week of life or, sometimes, within the first 1-2 days of life. Observational studies have suggested the etiology of the disease in term and near-term infants may be different than that postulated in the premature infant and could include entities such as cow’s milk protein–induced enterocolitis and glucose-6-phosphate dehydrogenase deficiency.”

            http://emedicine.medscape.com/article/977956-overview#a6

          • guest

            That does not prove that the benefits of breast milk are the same for term and premature infants AT ALL.

          • Azuran

            Your study is not taking into consideration the cause of breastfeeding arrest.
            A baby who has trouble breastfeeding is more likely to have formula supplementation at the hospital than a baby who is good at it from day 1. The baby with breastfeeding problems is more likely to eventually be switched to formula feeding.
            You are mixing up your cause and consequences.
            Most of those mother didn’t stop breastfeeding because their baby had formula. They stopped because their baby have trouble breastfeeding, which is also the reason why they needed supplementation in the hospital.
            Also, stopping because you prefer formula feeding or because BF was painful is a 100% legit reason. So those women tried formula feeding in the hospital and preferred that option. That’s a good thing, they experienced both and made their choice. That’s bodily authonomy.

          • nikkilee

            No, that is not true. I’ve worked in 6 different hospitals in maternity, and teach hundreds of healthcare workers. Formula use in the first few days creates breastfeeding challenges; formula feeding is still a default position in most hospitals, for a variety of reasons. As for choosing to feed formula, the most important thing is that a mother love her baby.

          • momofone

            What approach do you teach for working with mothers who, for whatever reason, do not plan to breastfeed?

          • Charybdis

            Don’t be silly, they aren’t taught anything at all, except that they should be breastfeeding and that they will have an intellectually, socially and challenged child who, by the way, is also going to be obese and a burden on society.

          • Irène Delse

            I guess we know why so many hospitals subscribe to terrible one-size-fits-all BFHI policies: they have nikkilee and her peers as instructors! Instructors who know in their heart of hearts, without reference to pesky research, that “formula creates challenges”. Never mind that they she has the causality backwards: women who experience breastfeeding challenges do use formula, because it’s better than a baby starving…

          • Bombshellrisa

            Formula in the first few days helped my son, born at 35 weeks. He could latch or suck. My milk didn’t come in for five days. Five days is a long time to expect a baby to wait to get some food.

          • Bombshellrisa

            Individuals are really what matter, you have had plenty of people here share their individual experiences. There have always been alternatives to breast milk, do you think that those early alternatives somehow were the cause of women not being able to breastfeed? That would be a ridiculous argument. As ridiculous as assuming that women are so brainless that they can’t assess their individual needs and decide how feeding their infant will fit into those needs. Having a free sample of formula can help families who need to use it. It doesn’t “make” someone not breastfeed.

          • nikkilee

            Formula companies don’t give their product away for nothing. They do it because it is a successful marketing strategy.

          • Bombshellrisa

            So how does giving samples to people make them unable to produce enough milk? And please use another argument then the one you tried about how supplementing will make your supply tank, as it’s impossible for someone who is making no milk to make less. Individual circumstances dictate what will will and a free can of formula can help.

          • guest

            When was the last time you saw a company give away free breast pads, nipple cream, or nursing bras?

          • KeeperOfTheBooks

            Well, I have seen companies (Lansinoh, in particular) give away free breast pads and nipple ointment. They do it for the same reason formula companies do: get moms to try a product for free that, by its nature, will need to be repurchased over and over again, moms will like the product/possibly feel brand loyalty to it due to yay free stuff, and are more likely to purchase it again in the future for those reasons.
            Funny, though. I planned on exclusively breastfeeding. Got the aforementioned pads and nipple ointment in my hospital gift bag. Still didn’t make my milk supply appear or increase, and didn’t force me to breastfeed against my will, either, once I decided to stop, just like having Similac in the house wasn’t the deciding factor in my choice to formula feed. It’s almost as though I’m an adult woman who’s capable of making her own decisions on these points…crazy, huh?

          • Bombshellrisa

            That is exactly it. A sample of formula isn’t going to dictate how your body functions.

          • demodocus

            We got a free onesie in ours from the local baseball team. DH and I still root for the ones we grew up with!

          • Bombshellrisa

            You got a free onesie? You mean you didn’t just switch teams because that freebie temped you to? You have your own mind, you say? Well, all be.

          • Megan

            We got a basket with a free box of pasta, jar of sauce, colander and pasta spoon so that we’d have a meal our first night home. Our local pasta sauce company is sure out to brainwash us. I’ll never make my own tomato sauce again….oh wait, I did just last week.

          • KeeperOfTheBooks

            Note to self: move to your city within the next couple of weeks. YUM!!

          • The Computer Ate My Nym

            Did you even read the abstract of the study you linked to? Here, let me help you with a relevant quote: “The most prevalent reasons mothers cited for in-hospital formula
            supplementation were: perceived insufficient milk supply (18%), signs of
            inadequate intake (16%), and poor latch or breastfeeding (14%).”

            Not included on list of most common reasons: “Hospital gave me some formula and I couldn’t resist continuing to use it.” Women stopped breastfeeding because it wasn’t working. If no formula was available then they went on and hoped for the best. Sometimes it worked–their milk supply improved, the baby only lost a little weight before recovering and took no lasting damage, etc–but sometimes it ended in disaster, readmission, and sometimes brain damage or death.

            Also note that the correlation with not exclusively breastfeeding was MUCH stronger than the correlation with no breastfeeding. Almost as though in some cases the supplementation worked as intended and allowed later successful breastfeeding for those who wished to try.

            I’d also like to see one of these studies show outcomes other than rate of breastfeeding. For example, baby weight, milestones met or failed, readmission, etc. REAL adverse outcomes, in other words.

          • nikkilee

            Every mother that gives milk doubts her milk supply; this is a perceived insufficiency. Lack of knowledge of normal newborn behaviors is a major reason for supplementing. Here’s the conclusion “Among women intending to exclusively breastfeed, in-hospital formula supplementation was associated with a nearly 2-fold greater risk of not fully breastfeeding days 30-60 and a nearly 3-fold risk of breastfeeding cessation by day 60, even after adjusting for strength of breastfeeding intentions”. Breastfeeding technique improves over time, with practical advice, encouragement, and practice. No relationship is perfect after 36-48 hours, the length of time a SVD is in hospital. This is the reason community support is important. I see this study differently than you do. I see it as a manifestation of the cultural distrust of breastfeeding, lack of confidence, and lack of support; things that are in the process of change.

          • The Computer Ate My Nym

            Every mother that gives milk doubts her milk supply

            For reasons that I refuse to go into on a public forum, I did not.

            Breastfeeding technique improves over time, with practical advice,
            encouragement, and practice. No relationship is perfect after 36-48
            hours,

            And a baby can be dead or permanently brain damaged from hypernatremia in that amount of time. It’s stupid not to supplement if a baby is not getting enough milk. Again, I would like to see a study look at REAL adverse outcomes like readmission, dehydration, etc. Not the “adverse outcome” of not breast feeding, which, at worst, is going to result in an extra cold or two.

          • nikkilee

            This is why AAP wants babies seen 2 or 3 days after hospital discharge.

            “The incidence of breastfeeding-related hypernatremia is 1-2%” according to this medical article from 2014. http://emedicine.medscape.com/article/907653-overview#a6

            Hypernatremic dehydration does occur in formula-fed infants, although in this study, at about half the number. http://ijn.mums.ac.ir/article_2641_385.html

            This study from 2014 says that the true incidence is unknown. http://www.uptodate.com/contents/hypernatremia-in-children

            When it is your baby, it is 100%.

          • Nick Sanders

            According to the CDC there were 3,988,076 babies born in the US in 2014.
            http://www.cdc.gov/nchs/nvss/births.htm

            Let’s split the difference on that 1-2% and call it 1.5%. That would be 59821 babies with breastfeeding-related hypernatremia, if they were all exclusively breastfed. Since the percentage is an estimate, we’ll only go to two sig figs, and to be generous to you, I’ll round down, so ~59,000.

            If formula fed infants experience it at half the rate, that would be 29,500, assuming the statistics cover both exclusive formula feeding and supplementation. Again, two sig figs, rounding down, 29,000. So that’s about 30,000 babies saved in one year.

            That seems like an important population to this individual.

          • swbarnes2

            That’s too small a study to get an accurate count for dehydration among formula fed infants, and I think you know that (1 baby out of 36 FF) This larger one puts the OR at 11.2; FF babies are only one tenth as likely to suffer from dehydration.

            http://archpedi.jamanetwork.com/article.aspx?articleid=191546

            Quote from this article:

            http://fn.bmj.com/content/early/2013/07/12/archdischild-2013-303898.full

            “Neonatal hypernatraemic dehydration is a complication that is almost unique to breastfeeding. This complication is rarely seen in an otherwise healthy, bottle-fed infant, ”

            This paper counted 70 EBF babies with dehydration, not a one was formula fed. They estimate that the % of EBF is LOW, at about 44%, so it’s NOT the formula feeders didn’t get this condition because so few babies are being formula fed.

            http://pediatrics.aappublications.org/content/116/3/e343

          • guest

            I also never doubted my supply. Nikki’s “never” claim is thereby proven false. (That’s the problem with talking – and making policies – in absolute terms, Nikki.)

          • Irène Delse

            First of all, this is a stunning assumption you’re making. You’re basically advocating that hospitals disregard what women communicate and lock then into a breastfeed-or-see-your-baby-starve situation. Hello, patient autonomy, anyone? Plus, as TCAMN explained, in this study, they counted as “failure” anything short of exclusive breastfeeding for 3 months.
            But why not simply accept that in many cases, this is not achievable and that a healthy BF relationship can be built through combo feeding? I know this is what my mother did: she enjoyed breastfeeding, but she also had to work, so while I was at the babysitter’s, i would get formula, and breastmilk in the evening with mom. All in all, I was breastfed for eight months. Not bad!

          • Megan

            “Every mother that gives milk doubts her milk supply; this is a perceived insufficiency. ”

            (Containing my anger) Not every mother who doubts her supply is wrong. Many of us are correct and do indeed have low supply. If the 5% number is correct (and I suspect from my experience that it is low and is probably more on the order of 15-20%), then 1 in 20 moms do not make enough milk. Stop insulting us. I knew I had low supply. I was right. LC’s were wrong.

          • FEDUP MD

            HAHAHA! Um, no. I made enough milk to feed a whole other baby. I didn’t doubt that I made enough milk because my breasts quadrupled in size in a day, everything I owned was soaked constantly, and my kids grew like weeds. So not EVERY mother doubts her milk supply, I would have been nuts to deny the evidence in front of my face.

        • fiftyfifty1

          Naw, the top 2 barriers to breastfeeding are the same as they have ever been: 1. The biology often fails 2. It’s frequently inconvenient

          • nikkilee

            Some of the major reasons women choose not to breastfeed are: they lack support, they have concerns about milk supply, and they are going back to work. The biology can fail, but this is rare when compared to the 4+ million women who give birth every years. Being a parent is inconvenient. Mothers going home with a newborn who are bottle-feeding formula don’t have an easy road either, because life with a newborn is tough. Where are their support groups? I don’t know of any.

          • AllieFoyle

            Those are some reasons that have been captured by the pro-breastfeeding research community. The way you conceptualize the research question matters. I’m pretty sure a lot of women don’t breastfeed because they simply don’t want to, they find it contributes to depression, poor psychosocial adjustment, or lack of sleep, and/or they find it physically uncomfortable, unpleasant, or painful. I don’t see how BFHI practice help with any of that.

          • nikkilee

            The research is strong that breastfeeding mothers are less depressed and get more sleep than those who are formula feeding or mixed feeding. Check out http://www.uppitysciencechick.com

          • momofone

            As you say, that may be true for populations, but is not necessarily so for individuals, yet you state it as universally true.

          • Box of Salt

            nikkilee, do you only read studies you like?
            What about these mothers?
            http://www.ncbi.nlm.nih.gov/pubmed/25138629

            “while the highest risk [of PPD] was found among women who had planned to breastfeed and had not gone on to breastfeed. . . . Our results underline the importance of providing expert breastfeeding support to women who want to breastfeed; but also, of providing compassionate support for women who had intended to breastfeed, but who find themselves unable to.”

          • DelphiniumFalcon

            And what if the mom is depressed? Not just depressed, but near or full blown post partum psychosis? But can’t take medication because it’s not proven safe in breastfeeding? And don’t say it doesn’t happen because that’s exactly what happened to my mom in the 80s.

            Yes I was breastfed. I was also dropped off at my grandparents for hours at a time because my mom’s PPD gave her urges to kill me. Lucky for me she somehow had enough presence of mind to give me to someone else like grandparents or my dad and put distance between her and me. But all should be fine because, hey, breastfeeding! Never mind that she could barely function and felt like she was going insane.

            When my sister was born in the 90s she took zero chances, even if that meant she would have to formula feed from birth so she could take proper medication. She was a much happier mother that actually got to enjoy her time with her infant daughter and older child.without having the urge to kill them. She was sane. I’d rather have a sane mother than a breastfeeding mother who wasn’t herself.

            By the way, you still haven’t picked out which child was breastfed and which wasn’t from my posts earlier. Two in each category were even taken by the same camera with the same lens so it should be easy, right? You’ve got a 50/50 chance.

          • AllieFoyle

            If people don’t study the effects of the pressure to BF on maternal mental health then they are going to miss a large part of the picture. So much of the research on infant development has been conducted by people who are already committed to the idea that BF is the holy grail of infant health. They believe it is necessary and protective and that bias is evident in their research questions, the structure of their research, and the conclusions they draw. It’s important to think about what questions they don’t ask, what evidence they don’t look at, what possibilities they don’t even consider…

          • DelphiniumFalcon

            My mom did so much to breastfeed me. I have a tongue thrust too so that made it even more difficult to keep me properly latched but she did it anyways. I also had expressed breast milk in bottles so I guess she “cheated” but it was that or let me starve when she went to cry her eyes out for being such a “weak” mom that she couldnt get rid of her PPD.

            We have a strong family history of depression and she was diagnosed witu clinical depression long before I was born so it really shouldn’t have gone on as long as it did for my poor mom since her doctors already had that information. But people didn’t really talk about PPD as a serious thing back then from what she’s described.

          • StephanieA

            I put off taking prophylactic antidepressants after delivery because I wanted to try to breastfeed (thanks to working in a BFH I felt a ton of pressure). Three months postpartum I’m irritable, angry, and having thoughts of hurting my kids. It is so scary. I’m on medication now, and I’ve learned that if we have another baby I will start medication immediately and go straight to formula.

          • DelphiniumFalcon

            That’s what my aunt did. She gets the shots to help dry up her supply so she doesn’t have that to deal with too. She has PPD almost as bad as my mom so we think it’s a good choice.

          • AllieFoyle

            Correlation vs. causation. Look it up. See also: selection bias.

          • guest

            Uppity Science Chick? Yeah, that sound legit.

          • Nick Sanders

            There are plenty of good science writers with interesting pen/page names: Skeptical Raptor, Farm Babe, The Credible Hulk. I don’t know who Uppity Science Chick is, but I’m not going to write her off just because she had fun with her name.

            On the other hand, her status as a lactation consultant makes me want to take her claims with a grain of salt.

          • Elizabeth A

            Probably because women who feel fine and get enough sleep while breast feeding don’t switch over to other options. Correlations not causation.

            Also, try direct linking to the article. All I’m getting from your link is the blog banner with it’s infuriating thing about women and science.

          • nikkilee

            There are topics in the right hand menu that are relevant.

          • AllieFoyle

            Maybe, but it’s still not an actual citation. You keep posting links to websites. What actual studies do you have in mind? Just link to them, please.

          • KeeperOfTheBooks

            As I understand it, the research shows that moms who *plan* on breastfeeding and *succeed* at it are less depressed. It’s a bit different for those who try their damnedest but fail. Not terribly surprising that someone who achieves a goal gets an emotional boost from that, while someone who doesn’t, for whatever reason, gets quite the opposite.

          • swbarnes2

            Since both breastfeeding and depression are hormonal, it could very well be that the hormone conditions that make a mother have a good supply are the same ones that are protecting her mental health.
            And of course sleep deprivation is a big player in PPD; a block of sleep that is possible due to a bottle given by a partner (whose hormones are not making them vulnerable to PPD) could make a a really big difference in a new mother’s mental health which is likely to affect all sorts of things (like her ability to overcome breatfeeding issues)

          • KeeperOfTheBooks

            Having a decent block of sleep regularly wouldn’t have cured my PPD, but it sure would have lightened it. I still remember the first time I got 4 hours of uninterrupted sleep after DD was born, followed by a shower and a square meal. I felt like Superwoman!

          • KeeperOfTheBooks

            Re your first: I suspect that PPD may be the result of any, some, or all of hormonal issues/societal issues/psychological issues/etc. So yep, good supply correlating to good mental health wouldn’t shock me in the least.

          • corblimeybot

            My postpartum depression almost totally disappeared once I gave up breastfeeding. Also in the first few months that I breastfed, every session brought on intense feelings of despair and suicide ideation. After each session was over, the feeling abruptly lifted.

            I had no psychological trauma issues related to my breasts, or to breastfeeding. I was getting no less or more sleep than the average new mother. It was an involuntary, uncontrollable reaction to whatever hormones are associated with breastfeeding.

            Breastfeeding caused the most profoundly dangerous depression that I have ever experienced. My primary care doctor advised me to stop, and he was right.

            Go on. Tell me I’m not real, or that I don’t count.

          • Who?

            I’m so sorry you went through all that and that you had a safe, reliable and non-traumatising way to feed your baby.

            My guess is nickilee will ignore your post.

          • corblimeybot

            Thanks so much! Formula is a lifesaver, no question.

            My former primary care doctor was a good guy. I wish he was still my doctor. He made sure to thoroughly explain to me why breastfeeding should never take precedence over a mother’s mental health.

            I was no lactivist, and we even supplemented. But I still needed to hear that I wasn’t imagining things. Thank God for that doctor. I saw many doctors and a postpartum therapist during this time period, and he was the only one to realize that breastfeeding was causing my depression.

          • AllieFoyle

            That’s not a citation.

          • nikkilee

            Here’s a summary of several studies by Dr. Kendall-Tackett about sleep. Note the comments reflect a wide range of experiences. https://www.scienceandsensibility.org/blog/nighttime-breastfeeding-and-maternal-mental-health

          • AllieFoyle

            Ok, again, this is a link to a Lamaze article. They give terrible misinformation about the risks of interventions in childbirth, so I tend not to trust them as sources, but I do appreciate your earnestness so I took a look.

            The first study looks at 33 total women, only 7 of which are formula feeding! How is that supposed to be meaningful?

            I’ll look at the other studies too, but you have to wonder about the validity of this kind of research. Some of these are very small samples, and the measurements of sleep length and quality are rather suspect. Also, are there other differences between EBF and FF moms that might make a difference? Do women who are committed to and enjoy BF just more likely to be able to sleep well and be less depressed than women who are having difficulties or feel guilty that they aren’t meeting some standard of mothering? Are committed BFers just more likely to report positive outcomes? Do the BF mothers have less work commitments or a more flexible sleep schedule? What happens if the FF mother is sharing feeding with the father or other family member — surely she gets better sleep than either a BF or FF mother who does all the feeding herself?

            It’s interesting to note that even on a Lamaze blog there are a good proportion of commenters saying that BF did contribute to their depression. Whatever your studies show, they clearly aren’t capturing the experiences of a lot of women. Finding that something works fine for 51% and horribly for 49%, and then suggesting that what works for the 51% is the right and only way and then calling this recommendation evidence-based is bad science, bad policy, and bad clinical practice.

          • StephanieA

            No. Just no. I have had pretty severe PPD after both pregnancies, and breastfeeding only made it worse. Our first son was an awful sleeper regardless, but bottle feeding allowed my husband to take his turn during the night. I was able to go wander around Target by myself when baby was 4 days old while my husband stayed home and bottle fed. I breastfed our second son for a bit longer, and noticed that every time he fed I felt anxious and lost my appetite. Loss of appetite is a big indicator of PPD for me, so the fact that nursing exacerbated it scared me. This baby is also a giant that fed constantly. I felt like I couldn’t leave my couch, let alone get out of the house. Isolation feeds into PPD, and I felt very isolated breastfeeding. Baby started sleeping 5-6 hour stretches when we switched to formula. Do not tell me that I got more sleep breastfeeding, because it is utter BS.

          • Who?

            If you get a response, it will be along the lines of ‘well, at a population level…’.

            Sorry you went through all that, glad things are going better now.

          • Bombshellrisa

            Being able to leave the house even for an hour made a huge difference to me, I remember going to the grocery store that is up the road and sitting by myself and having a cup of Starbucks coffee and savoring the fact that I was by myself. Nobody needed me, no worrying about a kid whining or baby crying. Just me and my cup of coffee. I had severe depression during pregnancy, I looked for anyway to cope and not make things worse after I gave birth.

          • Kelly

            My husband just took the two younger ones to go pick up their sister at my parent’s house three hours away. He spent the night at their house which gave me 24 hours of uninterrupted me time. I was able to sleep in, sit on my butt and watch t.v., and actually be able to clean the house. I had no responsibility and I could not have done that if I was breastfeeding. It even gave me time to sorta miss them. It was so wonderful, I am going to ask for this for my birthday every year.

          • The Computer Ate My Nym

            I went to look up the primary sources for this claim with mixed results: Some studies claim an effect, others seem to suggest that the causal connection, if any, runs the other way (i.e. women with breastfeeding problems are more likely to become depressed, probably because society is telling them that they’re shit moms if they don’t breastfeed until the spawn graduates college).

            That aside, I also found this: Epidural anesthesia reduces PPD. If this result holds up in further testing and it looks like the causal link is the right direction, will NCB people start arguing that all women should have epidurals? For that matter, will cost conscious OBs?

          • Nick Sanders

            You seem to be confusing “is” and “ought”. Just because raising a newborn is hard, doesn’t mean we should work to make sure it stays hard.

          • Bombshellrisa

            Omg yes! Seriously!
            Dr Amy’s “save your energy” advice really struck a cord with me. I have never been given this advice when it came to parenting. I needed to hear it and being able to apply it to what is going on in parenting world at my house had made a difference

          • guest

            THIS. (Seriously, dude, you are my secret pretend internet BFF.)

          • Nick Sanders

            Well, thank you!

          • KeeperOfTheBooks

            Yes yes yes YES.
            “The most miserable mom wins” should not be a slogan of motherhood.

          • Bombshellrisa

            Oh please. Maybe they make their own support systems and being able to have someone else feed their infant is built into that. If you can have someone else feed your baby, you can leave the baby for a little while. You can get some fresh air at the park, you can go to the grocery store, you can hide at the library with a book. You might not have a group of women gathering every week to validate your decision like a breastfeeding group would, but you have the ability to have your own space and moments to yourself, which are highly important to a lot of women. Being a parent is hard and there are a million choices involved, you have to be able to be confident enough to have some backbone. It would help tremendously if people kept their opinions about those choices to themselves and didn’t try and “prove” through internet links how “wrong” things like epidurals and formula are.

          • Irène Delse

            They lack support? You mean they lack paid maternity leave. Everybody is by now, know that breastfeeding is a good thing.

            They have concerns about supply? Maybe because they have had problems with a previous child. Or maybe they just think in term of priorities: what’s more important, be assured that your baby will be fed in case you don’t have enough milk, or stay true to the EBF path? Considering that a not negligible % of women will have some trouble with breastfeeding, especially in the days immediately after birth, this is reasonable.

          • Monkey Professor for a Head

            What do you mean by support. More importantly, what do formula feeding parents mean by support. Support is a very vague term.

          • Monkey Professor for a Head

            I’ve breastfed my son for the last 11 months. I’ve never needed to use formula.

            Things that helped me breastfeed successfully.
            – being lucky enough with my genetics that I produced good amounts of milk with no effort.
            – having a husband who makes enough money so that I don’t have to work. If I had gone back to work, given my profession I would likely have found it difficult to find enough time to pump regularly.
            – having our parents around during the first month to help. My mum in particular was incredible- every time I breastfed during the day she would bring me a glass of milk and some chocolate, then she would take the baby to burp him afterwards. She would also send me off to sleep during the day and give him a bottle of expressed milk while I slept.
            – the community midwife who visited after I left hospital and gave me practical advice on latch and position.

            Things that did not help me breastfeed
            – Attending a breastfeeding class that was basically was 2 hours of telling women who want to breastfeed how awesome breastfeeding is
            – Being given a hyperbolic list of the risks of formula
            – the lactation consultant in hospital

            Things that nearly stopped me from breastfeeding
            – Being forced to look after a newborn on my own at night when badly sleep deprived and still dizzy from post partum blood loss. I was so desperate to get some rest that I rushed through night feeds instead of working to get a good latch, and ended up with painful damaged nipples. It was so bad that the first night I got home, I hand expressed and syringe fed because it was too painful to breastfeed.

          • nikkilee

            You forgot to give credit to your self.

          • Monkey Professor for a Head

            There was some effort by myself, true. But mainly my body lactated without any conscious effort from myself. There are so many women who put in far more effort than I did and still are not able to exclusively breastfeed. I would feel very odd in giving myself credit over those women who worked much much harder for it. It would be like giving myself credit for having a functioning pancreas or for good eyesight.

          • BeatriceC

            Hey, congrats! Your boobs worked! You should tell everybody how superior you are for that.

          • Squillo

            This was almost exactly my experience with my second child.

            My first ended up be combo fed because, despite having a hospital-grade pump, an office with a door, and discretion over my schedule, I could never pump enough to get my first kid through a day at daycare.

          • Box of Salt

            nikkilee “Where are their [bottle-feeding] support groups? I don’t know of any.”

            Why don’t you start some? Instead of berating the formula users, support ALL mothers. Why don’t you stop promoting the treatment of a huge chunk of the female population as second class citizens?

          • KeeperOfTheBooks

            Exactly. At the end of the day, moms are all, well, moms. We want the best for our kids, period. In the first world, breastfeeding term babies doesn’t convey many benefits, but if that’s what mom wants, support her! She’s just gotten comfortable when the toddler decides to lose his mind on the slide? Offer to go fetch him for her! A bottle-feeding mom is trying to juggle mixing a bottle, holding a baby, and getting a snack for the toddler? Ask what you can do for her! That’s what a community should do, and why put up further barriers in a community over something as meaningless as what your kid eats for the first year (or three?).

          • Guest

            You know what would help immensely – respite care in the hospital. I have 3-kids that I’ve breastfed for 12 months+. I gave birth to my second in a Baby Friendly hospital and I absolutely hated it. I had a relatively uncomplicated vaginal birth, so we’re not talking a rare case here – but – by the time our first night rolled around my husband and I had had 1 hour of sleep in 48 hours. One. And my baby didn’t want to sleep in the bassinet. I sat in the dim room trying to rock him and repeatedly nodding off. Which is only natural after 2 days of no sleep and the huge physical activity of delivering a baby! And guess what, no well baby nursery and my support person was just as exhausted as I was. What a disaster, and so incredibly unsafe. Thankfully our angel nurse broke the rules and took him for 4 hours so we could sleep. I woke feeling like a new person and that allowed me to keep our nursing relationship going.

            With my first baby I easily kept her in the room with us because I wanted to. With my third I deliberately picked a hospital that wasn’t Baby Friendly. It was wonderful.

            What’s wrong with a choice based on each individual person’s needs and desires? Baby Friendly is a menace.

          • Bombshellrisa

            Oh, you know she is just going to make her “populations” argument, individuals matter less than zero to her.

          • Guest

            I still shudder to think what could have happened if the nurse had refused to take him. I had already caught him rolling out of my arms once. Are dead babies an acceptable price to pay for….what? A few less illnesses “on a population level.” That’s insane.

            I’d rather see more people formula feeding than this climate. It’s just not worth it.

            Even if, IF, Baby Friendly was a response to hospital policies preferring formula feeding, this is not the answer. As the old adage goes, two wrongs don’t make a right.

          • demodocus

            Well, a dead baby does have fewer illnesses.
            /deep snark.

          • demodocus

            Apparently, I’m feeling particularly sarcastic tonight

          • Bombshellrisa

            I was going to suggest that we are talking to Brooke’s mother here but held back

          • Sarah

            In fairness to nikkilee, she hasn’t had a go at anyone for being infertile yet.

          • Bombshellrisa

            I was thinking the same thing. I also would like to see the readmission rates for newborns who are born in BFHs and advised against supplementing with formula.

          • Bombshellrisa

            I can only imagine. The sleep deprivation is real and no hospital is doing parents any kind of favor if they are trying to make their breastfeeding numbers look better while sacrificing the well being of mothers and babies.

          • Charybdis

            Then she should be fine with the fact that breastfeeding in a first world country with reliable access to clean, safe water only results in a few less GI issues and respiratory illnesses ACROSS THE ENTIRE POPULATION.

            But she doesn’t appear to be.

          • guest

            Ummmm WHY can’t they go to the same support group the breastfeeders go to? The whole thing is a stupid artificial division created by lactivists. Yes, in the beginning it made sense. So many people thought breastfeeding was gross and inappropriate, and the breastfeeders want to stick together. But that sort of thing happens relatively infrequently now, particularly among other recently postpartum women. There is NO reason a support group couldn’t cover both.

            But it’s inconceivable to you, isn’t it? And that’s why you’re part of the problem.

          • nikkilee

            That’s a fabulous idea. A new mothers group. Do you all on this list think it would work?

          • Elizabeth A

            Like the ones people run into on playgrounds and at Mommy & Me classes? The ones advertised by flyers at coffee shops and churches and community centers? You know, people sometimes have trouble finding the right fit in those, but they aren’t some kind of revolution – they exist and they work fine.

          • momofone

            Or what about teaching individual mothers about feeding options, and how to use them safely? “How do you want to feed your baby, and what can I do to help?” They can group themselves if they choose.

          • fiftyfifty1

            Oh you can’t trust individual mothers to make decisions for themselves!!! What are they, adults?!

          • nikkilee

            How about a general new mom group for all mothers, to deal with issues they bring up? Feeding may not be the issue.

          • momofone

            That’s certainly an option for those who want a group, but I wonder if it may not be more feasible to choose a focus–in this case, feeding–and address that. I say this having done a fair bit of group work; what is the scope of what you want to do, and how realistic is it that you can do it in your setting? Do you mean in the hospital? After discharge? Is there something you can focus on in your setting that may be more immediately relevant to what you want to accomplish?

          • KeeperOfTheBooks

            We have a playgroup like that in our neighborhood, and it works brilliantly for exactly that purpose. The toddlers wear themselves out on the playground, and the moms and babies hang out and talk. It’s not a support group per se; it’s a gathering of moms and grandmas who happen to both be neighbors and taking care of kids during the day. No one cares how you feed your baby as long as baby is fed. There are a couple of moms in it who breastfeed, a couple who bottle-feed, and some who combine the two.
            Recently, one breastfeeding mom was having a hard time: baby was about 4 months old, and waking up all night long to nurse. Mom was exhausted from sleep deprivation and chasing after her older kids. Various of us suggested ways to keep breastfeeding, if that’s what she wanted, but to get more rest: hand off the kids to dad when he got home from work so she could sleep 2 hours straight, pump and have dad give a bottle at night, and so on. Eventually, she decided to go to one bottle of formula/night given by dad, and nurse during the day. No judgment either way from us; the only question that got asked was “so what formula are you using? I bought several boxes of Brand X, but baby didn’t like it, so if you want it you’re welcome to it.” That’s the way it’s supposed to be!

          • The Bofa on the Sofa

            Ad Charybdis notes above, the biggest problem would be judgemental lactivists. If you are expanding beyond feeding, then it’s the APers. If you can avoid that crap, sure, it can and does work great.

          • Charybdis

            I’d like to think that it would, but it probably wouldn’t work too well. Mainly because the aggressive breastfeeders would group on one side to praise and reaffirm their “superior” choice leaving the bottle feeders (notice I said BOTTLE, not just formula) to their own devices.

          • nikkilee

            I’ve thought about this, because it bothers me that mothers who choose not to breastfeed don’t get special attention. It would take a loving and skilled facilitator to get this going. What all mothers have in common is life with a newborn. . .not easy. Perhaps that could be the common ground?

          • Megan

            Oh, they get special attention alright. It comes in the form of people, like yourself, telling us how our kids will be fat, diabetic, dumb and a scourge on society and how we as their moms will all get breast cancer and never lose our pregnancy weight.

          • guest

            It would work if it had leadership that was committed to accepting all methods of feeding and making that clear from the outset.

            That is, in fact, how I ran the group for the new mothers with kids born at the same time as mine.

          • moto_librarian

            It depends on who happens to be leading it. If it’s some clueless, agenda-driven moron like you, chances are low that it will work. I wouldn’t go to a place where someone was constantly judging me for bottle-feeding my child.

            BTW, have you finished the PROBIT study yet?

          • AllieFoyle

            I don’t mean to be rude, but are you….unaware that groups for mothers that don’t exclude non-breastfeeders already exist?

          • nikkilee

            No. . .I know of Mommy and Me classes, and infant classes for swimming and yoga, but I am ignorant of those groups. What are they called? Is there a national network?

          • Bombshellrisa

            In this area it’s MoPS, aka Mothers of Preschoolers (age ranges of the kids is birth to 5).

          • Elizabeth A

            Does there need to be a national network?

            I mean, what they were called in my neighborhood was New Moms Meetup! Date, Time, Parish Hall.

          • An Actual Attorney

            My city has an infant “playgroup” that meets at coffee shops and libraries, and a Baby Bar takeover that happens about monthly, infant friendly movie showings, and a few bars that do weekly baby friendly happy hour. Plus Boogie Babes, which I think is national. I know a city is different, but we can’t be a total anomaly. When you don’t define parents by how they feed a baby, there are lots of opportunities to find a group.

          • nikkilee

            No need for a national network. Cool idea. I am thinking about it.

          • Kelly

            Or, my baby is not strong enough to latch and get milk out or my baby is a freakin piranha and made me bleed so badly the LC gasped and told me to stop on that side. I had support from my husband, my mom, the LC, and the nurses. I can fill a freezer with my breastmilk and still feed my baby but I still did not even try with my third baby because it all sucked so much. I was a miserable weepy mess the first two weeks of my older two children’s lives, my oldest had a very hard time adjusting to a sibling, and I developed PPD which affected my relationships with everyone. While I developed PPD with my third formula fed baby, I did much better because I was not attached to a baby or a pump. Support will not make the biology work. I had different problems with two different kids and there is no way I would try again.

          • J.B.

            Pumping sucks (pun intended). Pumping while traveling is it’s own breed of challenge and getting mastitis from only managing to pump twice one day was no fun. Forcing babies to room in is just as paternalistic and damaging to the moms who need a break as taking babies who’s moms would be more comfortable with them in the room to the nursery.

            Fearless formula feeder has started some support groups, I’m sure they’d like more if you want to help.

    • KeeperOfTheBooks

      How tall are you?
      I know that I and others sound like a broken record on this point, but bassinets in a lot of the US, it seems, just aren’t set up for moms of below-, average, or even above-average height to reach. I’m 5’3″; even with the bed at its highest, I couldn’t put DD in the bassinet or take her out because it was so tall. One commenter mentioned being 5’10” and STILL being too short to do so. I had a CS, so I couldn’t get out of bed to put her in and out of the bassinet for the first 24 hours, and even then couldn’t do so safely because I needed my hands and arms to help get me out of bed.

  • Ayr

    I have a feeling that one of my friends has fallen victim to the BFHI way of thinking. My friend has an eating disorder, though she is in denial about it, and she insisted on solely breastfeeding her son until he was able to eat solids, however she didn’t produce enough, and her son has been classified as failure to thrive, he is 14 months and is just now crawling. He has been sick since he was born and his pediatrician says the only thing wrong with him is that he has acid reflux, yet I have seen this boy all sorts of things and never once did he get sick, as long as his father or someone other than his mother feeds him. If she feeds him, he instantly gets fussy and stressed, like he can literally sense her own struggle with food. Now he won’t eat at all and she has finally realized that something needs to be done and is taking him to a specialist, but this all started because she refused to admit that she couldn’t produce enough milk and refused to supplement with formula, which may have helped her son be healthier.
    All that to say this, the BFHI needs to end, it is not safe for mothers and babies, especially babies. I am thankful that the hospital I gave birth to my son at is not part of it.

    • The Bofa on the Sofa

      ack!

    • demodocus

      geez

  • CanDoc

    Yes, this. Thank your for this incisive call to arms.

  • prolifefeminist

    So my fourth baby was a vbac turned csection, and I was at a bfhi hospital. My husband went home every night to take care of our other kids, and I distinctly remember being in tremendous pain while struggling to get up out of bed to retrieve my newborn from his bassinet to feed him…and struggling again to put him back in his bassinet when I was done nursing him. SO NOT SAFE. I was on strong narcotic pain meds and still in a lot of pain when I moved, and trying to juggle sitting upright and getting my feet planted on the floor with a newborn in my arms? Forget it. I ended up trying to lay him safely on the bed while I tried to get on my feet, and then carefully picking him up and putting him in his bassinet, then trying to climb back into bed while in oh so much pain. And then her cry again, and I’d cry, because I’d just managed to get myself back in over, and knew that if have to repeat the whole process again. NOTHING about this is baby friendly or mother friendly. The nurses did their best but had no where to bring my boy so that I could rest. No one was there with me to hand me the baby, or safely take him from me. Tell me – on what other hospital ward is it smart to have a post-op patient on narcotics handling a newborn infant? Talk about sexism. Nowhere else in a hospital would this bullshit EVER be tolerated.

    • Old Lady

      Recovering from my c-section was like this but luckily I had two people with me (but I also had twins) to help with the babies so I didn’t have to struggle with moving the baby like you did.

    • KeeperOfTheBooks

      I did the same “set baby on bed, try to get myself out/in” thing. Because it took me some time to get full control of my legs and core (you never know how much you use your core until you can’t use it!), I would have to use my hands to pick up my leg, swing it over DD, and set it on the floor. Even so, I nudged her accidentally a few times, and she could have fallen. Insane, innit?!

    • Allison

      Yessss. Been there and it’s oh so awful. I had two c-sections and the pain getting up and down while on Dilaudid is just unreal.

    • Young CC Prof

      I can’t imagine. I had a planned c-section, I had a pretty easy recovery, but at one day after, there’s no way I could have carried around the baby safely. It was REALLY HARD to get out of bed the first couple days, and trying to move a baby at the same time would have been insane.

  • sdsures

    A friend here in England insists that babies are not in danger from such things here, like falling out of bed. I was unaware that gravity works differently over here. Apparently c-sections are also instantly recovered from, so the mom should be able to bounce out of beed immediately after surgery.

    (snark)

    • guest

      OMG. The first time I was encouraged to get out of bed post c-section it took 15 minutes to walk 15 feet to the bathroom, and a nurses aid was assisting me the whole way. And she wouldn’t let me try to pee alone, either. I cannot imagine trying to do the same (which was a necessary part of my own recovery) while minding an infant.

      • sdsures

        I’ve ad major abdominal surgery before so I have some idea of what I’m in for. Obviously a shunt revision isn’t the same as recovering from a deep tissues incisions with a baby to care for. But yeah, the slow walking with support? Yep. After a shunt revision to the abdomen and/or skull, I wasn’t allowed to pee alone either.

        When you have cats, you never pee alone. It’s good practice.

        • guest

          I had an appendectomy as a teenager. FWIW, I found the post-op sensations of the c-section to be very similar to that. The incision is bigger, but the overall pain, the kinds of movements that were difficult, etc. – it matched my memory of the first abdominal surgery. It helped to have the prior experience. I remembered the feeling where your body no longer knows how to pee. The whole thing was far less harrowing then when I was a scared teenager with no idea what to expect. Of course, I have no idea of a shunt revision is similar to an appendectomy!

          • sdsures

            Well, you’re not cutting into any organs, for a start – you might be moving them around a bit. But the catheter is very slim and long, and can be coiled a lot quite safely. Little kids can only have so much catheter put in their abdominal cavity, and then eventully as they grow they need more catheter. My scar is about …. *grabs handy measuring tape for knitting*… 3 inches long. It was first done in the days before laparosopy (1981), and it’s been reused for a few subsequent revisions, which is safe.

    • Jennifer

      And yet she’d probably be one of the people trying to talk pregnant women out of a c-section by going on and on about how it’s major surgery and takes months to recover.

  • Brooke

    So no statistical evidence that there is increased harm to babies aside from one study that looked at bed sharing which is not recommended in the Baby Friendly Hospital Initiative. Funny how you can share screenshots from birth groups to humiliate mothers who’ve lost a child but not share any evidence of all these emails you’ve recieved.

    • KeeperOfTheBooks

      So, if mom can’t put baby in the bassinet without getting out of bed, physically can’t get out of bed herself (or can’t while holding baby), and is denied any and all respite care, you don’t think that’s a scenario that pretty much writes the bed-sharing conclusion itself?
      I couldn’t get out of bed for 24 hours after my CS. I was too short to put baby into the bassinet if I was in the bed. Staff (thanks, BFH!) was so low that they couldn’t help me because by the time I’d get someone into the room for a non-emergency, baby’d be awake and crying again for more food that I couldn’t give her, but I’d try and try and try to get her to latch–which she would, for a minute, before screaming again because she wasn’t getting a damn thing.
      But hey, just because mom hasn’t slept more than an hour straight for the last three days, is recovering from major surgery, and is on opiods is no reason not to expect her to solo newborn care! I mean, CPS totally wouldn’t be called in any other circumstance in which someone said “I know what sounds like a good idea! I’ll leave my baby in the care of someone suffering from extreme sleep deprivation, recovering from major surgery, and on opioid pain relief! There isn’t anyone there to help her, but that’s not a problem, right? Oh, and she can’t get out of bed while holding the baby, but doesn’t have anywhere to put the baby while she’s getting out of bed. Perfect!”

      • sdsures

        *huggles* I’m 4′ 11″. :'(

        • KeeperOfTheBooks

          I’m short, but not especially short for a woman–5’3″. I estimate that the bed/bassinet transfer with the equipment heights at my hospital would require a mom to be about 5’7″ or upwards, well above average height in the US, and that’s assuming that the bed was as high as it would go!

          • MLE

            I am 5′ 10″ and it was still extremely difficult for me, both times.

          • demodocus

            me too

          • Megan

            Hate those damned bassinets. I’m 5’2″… almost.

      • Sarah

        OMG, just because you put things in place so a certain outcome is inevitable, doesn’t mean you can get blamed when it happens! Totes unfair. Formula shill.

    • guest

      Sweetie pie, there are SO MANY COMMENTS on this blog that say the same thing.

    • Young CC Prof

      Just a few weeks ago, the Academy of Breastfeeding Medicine published a meta-analysis of the BFHI. It clearly showed that, although BFHI increases the rate of exclusive breastfeeding during hospital stay (which is a stupid and dangerous metric) it does NOT increase the rate of breastfeeding success over a longer period of time.

      BFHI doesn’t work. It causes skull fractures, it causes suffocation deaths, it causes babies to suffer brain injury from starvation. Any questions?

      • Amazed

        Yes. You aren’t a newbie here. You know what kind of creature you’re dealing with. Why are you still trying to apply reason?!

      • Fleur

        I actually think it’s a counterproductive approach if you want to increase the percentage of mothers breastfeeding long-term. I’d say that more than half of the mothers I know had to supplement with formula in the first couple of weeks after the birth, because their milk took too long to come in and/or due to other issues such as tongue tie. If you tell women that just one bottle of formula is enough to destroy their chances of breastfeeding and ruin the baby forever (scary music), how many women are going to throw in the towel there and then and think “oh well, I might as well exclusively formula feed now, seeing as my baby’s already lost all the potential benefits from breastfeeding”. I certainly would have done, if one of the saner health visitors hadn’t suggested that I give combo feeding a try. It wouldn’t have been the end of the world if I’d stopped breastfeeding after 5 days, of course, but breastfeeding got a lot more fun later so it would have been a pity to miss out on that purely due to lactivist propaganda.

        • Jules B

          Exactly. I am 99% sure my supply issues were inherent – I had some of the “symptoms” of that inadequate milk duct syndrome (forget the name), such as my breast size not increasing during pregnancy etc. But my high level of exhaustion due to trying to “force-nurse” a very sleepy/jaundiced baby, plus pumping every 2-3 hours around the clock to increase my supply/supplement certainly didn’t help matters either. If anyone in any position of authority (my doctor, the public health nurses) had only said “A few bottles of formula won’t hurt, and may even help” at that early stage, I am *convinced* my daughter would not have ended up rejecting the boob wholesale, because there would not have been this negative feedback loop set up for us with nursing. If I had been told it was ok to give a bit of formula, I could have gotten some rest versus literally panicking over not producing enough. And I could have nursed in a more relaxed manner, knowing my baby was Ok/getting enough food, and that no doubt would have improved the experience for her too (she used to get very frustrated with my low supply, pull off and scream etc).

          In short, new mothers really do need to be given accurate unbiased information. We can handle it, dammit.

      • Margo

        Of course there would be increased rates during hospital stay as that is the only option pushed down your throat, unless partners bring in bottles and formula there is nothing to be done other than breastfeed. What utter bloody rubbish. Oh, makes my blood boil!!! From personal experience I have visited women at home who as soon as they were discharged from hospital never breastfed again because they had never wanted to in the first place, but the hospital being baby friendly had left them with very little choice. Hard to be staunch when exhausted and new to motherhood and no one on hand to make up formula for you.

        • Young CC Prof

          Precisely. Women are more likely to breastfeed in the hospital because they are bullied into it. But even among those who actually wanted to, BFHI hospitals do not appear to do a better job of helping them than other modern hospitals that support breastfeeding in a more balanced way.

          They may in fact be worse, because they are too reluctant to supplement. For a newborn who’s just beginning to suffer the effects of breastfeeding problems small bottle of formula, presented without judgement but with encouragement to keep trying, can actually make nursing work. Withholding the formula until the baby is actually sick, or sending the message that any formula is failure, is not going to do anyone any good.

    • Amazed

      Brooke, as always gloriously missing the point.
      You have suddenly developed empathy, thingy? Good. I am waiting to see your heartfelt apology to the women who cannot have children who you so casually insulted months ago and then, just in case someone was in doubt, chose to expand the insult by asking, “Sensitive much?”

      Only, I have the sneaking suspicion that your empathy is reserved for the kind of vermin that after killing their baby with homebirthing still rave how marvellous it was. You only defend your likes.

    • Azuran

      Hey everyone! If you ignore the evidences, there is no evidence!!!!!

    • Who?

      Bed sharing might not be recommended but it is the outcome when new mothers can’t move to put their babies down into a bassinet.

      I got stuck in a nursing chair hours after my son was born. Helped to settle in by a nurse who then left us both. I’m small, chair was big, baby was big (and about 1/3 of my body length). No buzzer within reach, no one else in the room, no one going past on the ward.

      And I’d had a short labour and fairly easy, unmedicated delivery.

      Newly delivered mothers need help, and sometimes medical attention themselves. Depriving them of that for the sake of pushing an unsubstantiated theory about infant feeding is just wrong.

      • One of the very first things drilled into us in nursing school, was to never, never, NEVER leave a patient unattended without a means to summon help. This is an imperative for any kind of patient.

        • KeeperOfTheBooks

          Hell, I had that drilled into me in my nurse *assistant* program! That, and to always lock the freaking wheels on any sort of device–bed, wheelchair, etc. Yet somehow, this apparently doesn’t apply to transferring a newborn from being in bed with mom to a bassinet…? Completely mad.

    • The Computer Ate My Nym

      Typically, in medicine, for a change in therapy to be made it is required that the new therapy show that it is better than the old or at least as good and has some other advantage (cheaper, fewer side effects, more convenient, able to be used in situations where the standard can not, etc). So there being no evidence that BFHI is harmful is not enough. Those proposing the change should be required to show that it is helpful and/or not harmful and has a secondary advantage. The absence of evidence is insufficient to justify the change.

    • Sarah

      Are you seriously preaching about lack of statistics to back up claims? Chienne, s’il vous plait.

    • Megan
      • Who?

        Horrifying.

      • nikkilee

        The last sentence in the Thach article cited reads, “In summary, the BF initiative is an important public health program benefiting infants in many ways, including reducing the incidence of childhood obesity.16,17 However, any extensive health
        program needs to be monitored for adverse effects and modified accordingly.”

        • I don’t think the BFHI has been around long enough to have any quality studies performed which show whether there is any effect on childhood obesity or not.

          What I have seen, among the subset of breastfeeding mothers who are opposed to pacifiers and who let the baby nurse endlessly instead, are some very obese babies. The babies are getting a continual dribble of milk so their total daily caloric intake is huge.

          • demodocus

            the dribbling was how i knew my boy was done. Even without my oversupply, i had no desire to comfort nurse. Snuggling and his dad’s singing always work. He did have a pacifier for a few months, too.

          • CSN0116

            So what’s the difference between BFHI and what Dr. Kramer did in Belarus for his control and experimental groups? I thought his experimental were patients in BFHI institutions. He started that study some 10+ years ago, right? I know his shown “benefits” of breastfeeding are totally lackluster, but he was able to drastically increase his long term breastfeeding rates in the experimental group, wasn’t he? Or am I making this up?

          • Gatita
          • Charybdis

            But breastfed babies CAN’T overeat. It is just not possible because the magic wonder breasts immediately sense and calibrate themselves to the *exact* amount needed by the baby in each and every feeding. /snark

            Really, though, have you noticed that a fat, chunky breastfed baby is *perfect* and “Good Job, Mama!” but a fat, chunky bottle fed baby is being force fed, overfed and not able to regulate their intake? How does that double standard work?

          • nikkilee

            Babies grow differently depending on what they are fed.

          • Nick Sanders

            Specifically, if their nutritional needs are met, they grow. If they aren’t, they don’t.

          • Guest

            Yes. Babies fed battery acid don’t grow at all, while babies fed breast milk or formula grow very well.

          • Amazed

            Spare me. Is this guilting tripe the best you can take from your profession? And even if it was true, how do “mamas” (still with this patronizing shit, I see. Do you think you’re being cute, or do you engage with idiots who need to be babytalked?) know the details of each baby’s growing chart and so on? If every dumb “mama” can make assessment, why does the world need the likes of you?

          • demodocus

            My EFF nephew and my EBF son look nearly like twins separated by 6 years. (One has blue eyes). *I* have to think a minute when my sister posts toddler pictures of her boy.
            ETA: don’t you DARE try to shame my sister. Stage IV cancer is nothing to f*#K with.

          • Megan

            We are having problems with my EFF 2 month old gaining weight right now. She is only 8th percentile. She has reflux and we assumed it was that but I looked at her growth chart and it is almost the exact same trajectory as her older sister, who started out on breastmilk. It’s almost like genetics are involved, huh?

          • demodocus

            weird, i know. Both our boys were early talkers, too. its like they’re related, lol

          • KeeperOfTheBooks

            Genetics? Surely not! What madness is this?!

          • Bombshellrisa

            That whole DNA thing is why my son who was born at 35 weeks was 19 1/2 inches tall. Because his grandmother was a 23 inch tall, 10 pound newborn. My son looks exactly like her. He also acts like his daddy. There isn’t much of me that I can see in him.

          • KeeperOfTheBooks

            DD was 21 inches long, but 8 pounds, and has stayed crazy long ever since. Facially, she looks a lot like me, but she’s going to end up very tall.

          • KeeperOfTheBooks

            At the risk of being terribly dark for a moment, you think that your nephew might thrive better long-term with a mom who’s, y’know, THERE, than with the knowledge that “mommy died when you were X months old, but at least she prioritized breastfeeding you for X months over getting the chemo she’d need to see you go to kindergarten?”
            (Believe me, I’m not at all making light of the nightmare that is cancer. The problem is, it seems like some lactivists seriously think this way.)

          • demodocus

            yup. Fortunately, my sister is lucky. Nephew is about to turn 9 and has ordered her that they’re going to visit us during summer vacation so they can officially meet the new baby. He’s getting bossy, lol

          • KeeperOfTheBooks

            Yay nephew, and double-yay demo-sis!

          • Bombshellrisa

            Bossy–oh, he must be vaccinated too!

          • Amazed

            Oh it’s different when a mom CAN’T breastfeed! She isn’t to be shamed!

            You know, I’m curious about a whiny tiny detail. We know the children of mothers who don’t breastfeed are more likely to grow up dumb and obese. But since it’s so different when a mother can’t breastfeed… just how much different is it? Are their babies still going to be unhealthy, stupid and fat, or does breastmilk has a way to transcend the inability to breastfeed since moms WANTED to?

          • demodocus

            No idea. I’m going to ff Kid2 though, and i “can” so long as i ignore the fact that i hate bf’ing

          • Bombshellrisa

            I am so tempted to post a pic of my exclusively formula fed husband. His mom was dying of cancer when he was born, so no breast milk for him. He is smart, lean, tall and (this is my bias coming through) totally handsome ( if dark and handsome happen to be someone’s cup of tea). Not only that, but he is patient, hardworking and a wonderful husband (and father!) which are MUCH more important things to be and not traits you get from how you were fed as an infant.

          • StephanieA

            I’ve thought about posting a picture of my oldest son. Because he is so freaking gorgeous. I’m obviously biased because I’m his mother, but we’ve had multiple strangers tell us he should be a child model. But maybe he would’ve been even more beautiful if I had breastfed him, right?

          • Charybdis

            Really? Do tell! Please, we are waiting with bated breath.

            Babies grow, period, when they are fed nutritious food. This includes both formula and breastmilk, solids when they are old enough, etc. A breastfed baby does not grow differently than a formula fed one, unless you count the ones who drop right off the growth charts because they are not getting enough breastmilk because the mother refuses to supplement or switch to formula completely.

          • nikkilee

            http://ajcn.nutrition.org/content/57/2/140.short

            Breast-fed infants are leaner than formula-fed infants at 1 y of age: the DARLING study.

          • nikkilee

            http://ajcn.nutrition.org/content/early/2012/01/30/ajcn.111.027284.short

            “Conclusion: Compared with breastfeeding, formula feeding is associated with altered body composition in infancy.”

          • Gatita

            But there’s nothing in the study about the effects of altered body composition. Does it matter? Does it have any long term impact on health? That’s like saying the gut biome is altered by formula. Unless you can demonstrate a negative health outcome it doesn’t matter.

          • Charybdis

            http://www.ncbi.nlm.nih.gov/pubmed/11099589

            CONCLUSION:
            Infant feeding mode is associated with differences in body composition in early infancy which do not persist into the second year of life.

            http://www.ncbi.nlm.nih.gov/pubmed/24673117

          • guest

            I was going to cut and paste more of that study:

            “RESULTS:

            Weight velocity was higher in FF than BF infants age 3 to 6 months, and higher in FF than BF girls 6 to 9 months of age. Adjusted for gender and baseline values, BF infants had lower total body water at 3 months, lower total body potassium at 3 to 24 months, and lower bone mineral content at 12 months. The multicomponent model indicated that FFM was lower in BF than FF infants at 3 months, and FM and %FM were higher in BF than FF infants at 3 and 6 months (boys only). Total body electric conductivity confirmed lower FFM in BF than FF infants at 3 months, as well as at 6 and 9 months; FM and %FM were higher in BF than FF at 3 and 6 months, and 9 months (boys only). Intakes of energy, protein, fat, and carbohydrate were lower in BF than FF infants at 3 and 6 months, and were positively correlated with weight gain and FFM gain, but not FM gain. No differences in nutrient intakes were observed at 12 or 24 months.

            CONCLUSION:

            Infant feeding mode is associated with differences in body composition in early infancy which do not persist into the second year of life.”

          • Amazed

            That’s why you’re talking about 2 years of age?

          • Gatita

            That study was published in 1993. 23 years ago. Got anything more recent?

          • nikkilee
          • Megan

            That is a study of PRETERM infants and only shows a different from birth to reaching their due date. From due date to age one it was inconclusive. Do you even read the studies you post? Plus, a premie gaining fat mass to catch up by their due date is a GOOD thing.

          • nikkilee

            The benefits of skin to skin don’t magically stop the instant the baby reaches its due date.

          • Megan

            Citation? You can’t just assume the benefits are of the same magnitude or are clinically significant in term infants.

          • Daleth

            Breast-fed infants are leaner than formula-fed infants at 1 y of age: the DARLING study.

            What does that have to do with obesity? Allowing for the ultra-rare freakish exception, which I’ve never seen and wasn’t mentioned in that study, one-year-old kids are not “obese.” Assuming they’re adequately nourished, they’re all somewhere between a little chubby and quite chubby.

            It’s not until they’re older that their bodies start trending towards leanness, average, overweight or obesity.

            And that study didn’t even LOOK AT older children or adolescents, much less attempt to reach conclusions about them. In a word, it has absolutely nothing to do with obesity.

          • Erin

            Well based on what mine has just eaten, he’s going to grow into this:

          • BeatriceC

            Yet I was pumping 30-40 ounces in a single 10-15 minute session for my 504 gram 24 week preemie.

            I’m pretty sure I would have been the village wet nurse in another era.

          • Charybdis

            Overachiever. 😛

          • StephanieA

            This! My sister was the chunkiest baby- rolls on rolls, everywhere. She doubled her birth weight by 2 months. But she was EBF, so she was paraded around the doctor’s office as a perfect example of a EBF baby. I highly doubt that would’ve happened if my mom had formula fed.

          • CSN0116

            The entire premise of using a food source, breast or bottle, as the main/sole calming mechanism is just not healthy, period.

            Stop being a #shitmom and expand your mind a bit to tailor your responses to your infant’s cries. Good moms don’t just uniformly respond. Special snowflakes deserve customized care /sarcasm.

          • momofone

            I never understood the people who said they didn’t know what they’d do when Snowflake weaned, because their only way of offering comfort/ending tantrums/etc would be gone. Why on earth would you feed to end a tantrum? Why not offer comfort as comfort, rather than food as comfort?

          • Megan

            Yeah, like a hug?

          • momofone

            Exactly! But then I saw breastfeeding as a way to feed my kid, not a lifestyle or a parenting philosophy, so what do I know?

          • Irène Delse

            So true! I never had a kid, but when my little niece was born, it was an education: I got to see how much a very young baby could interact with the people around. Her mother breastfed her, and enjoyed it, but she was also careful to have other ways to show the baby she was safe, loved, cared for. The baby took very early to pacifiers, which was a great help. But sometimes, just giving a hug, rocking her, or singing a little song, worked wonders.

          • Toni35

            ? None of my daughters (I have four) would accept the pacifier (lord knows I tried). Because of this, they did spend considerable time at the breast, for both nourishment and comfort (lucky me). Two of them settled into an average length, average weight growth curve (40th-60th percentiles) and remain there to this day (my 6 year old and my 4 year old). The other two settled into a growth curve that I would describe as just barely clinging on to the chart (10th percentile for both height and weight) and have remained there (my 9 year old and my 9 month old). I’m an average, to somewhat above average size woman (5’7″ 145 lbs). My husband is average to a little smaller than average size man (5’7″ 165 lbs), but the women in his family are quite petite. I suspect whom my daughters “take after” has more to do with their size than how often they nursed as babies.

            Does this subset of women who are opposed to pacifiers happen to be large themselves? It’s been my experience that it’s quite difficult to over feed a breastfed baby; when they comfort nurse they get little if any actual milk. If these babies are “obese”, perhaps it’s genetic…

          • nikkilee

            Come back when those babies are 2, and have been running around for a while. You’ll find that the vast majority have lengthened, and now lean.

          • momofone

            Does this not happen with babies who are fed formula?

          • Amazed

            Never. Babies grow differently depending on what they’re fed. Welcome to Nikkileeland.

            Clearly, the pediatrician who sees Amazing Niece is unaware that she’s EBF (so much that at her very first feeding she vomited because she couldn’t regulate her calorie intake. No meager drops of colostrum here. SIL was a prize cow from day one, pumping and throwing away three bottles at a feeding.) She thinks Amazing Niece is big for her age.

            Fun anecdote: the very next day SIL, Amazing Niece (and her pram), the Intruder, yours truly, and two men enter the elevator in the mall. It hesitates where to go. SIL looks at Amazing Niece and sighs, “You see? The doctor TOLD us you’re too fat! Now, the elevator can’t take off!”

          • nikkilee

            And CDC and WHO land. . . .growth charts used to be based on the growth of formula-fed babies. These were the ones given away by Ross. Lots of methodological flaws in them. Then the WHO did a multi-cultural study across 6 continents and created a growth chart based on breastfed babies, the physiologic norm. Totally different growth curves. http://www.cdc.gov/growthcharts/

          • Amazed

            And of course, every EBF baby that is over the norm MUST be charted according to this old faulty chart! How smart you are!

            How conceited must one be to automatically decide that doctors don’t know their stuff because she, as a LC, thinks that a EBF baby CANNOT be too big.

            That’s how distrust in doctors and hospitals is (lovingly) nurtured. A page that was last updated six (6!) years ago but of course, doctors wouldn’t know about those new discoveries. Only the Nickilees of the world do.

            How DARE you when you aren’t even a medic! When you starve a baby dangerously by proxy, you’ll send the mum to them uneducated, old-fashioned doctors to save him/her. Meanwhile, you’re busy happily bashing them. You’re a disgrace.

            The worst of all is that a trip to the ER with a starved baby is a GOOD thing. That would mean that you have at least seen the issues before the baby dies or is permanently harmed by starvation.

          • The Computer Ate My Nym

            And this is different from the formula fed babies…how? They also hit growth spurts and “lengthen”. They also run around and lose some of that baby fat to muscle. Where are the data saying that one group is less likely to be obese than the other at age 2?

          • DelphiniumFalcon

            Yeah, I guess someone should tell my formula fed 5’8″ and lean fighting machine sister that just dropped a weight class that she’s a fat ass that stares at the TV all day. Because she was formula fed. She needs a good laugh between tournaments.

          • Megan

            Kind of like my formula fed 20 month old who needs 12 or 18 month pants size for the waist?

          • moto_librarian

            Sounds like my now 4 year-old formula fed son who is just now fitting 3T pants.

          • demodocus

            or my bf’d 2 yo in 3T

          • KeeperOfTheBooks

            Well, my mostly-formula-fed 2-year-old *is* wearing some 4T clothes, but that’s because she’s so freaking TALL, and the only reason the skirts/shorts will stay up is that the cloth diaper pads them out. You can see the kid’s ribs, for goodness’ sakes! (Not terribly prominently, she’s not over-skinny, but fat she most definitely ain’t.)

          • Megan

            That’s my kid too. I started to get worried because her 18 month and 2T pants were suddenly baggy and no longer fitting but then I realized she suddenly could reach the doorknobs (a whole other issue…) and had just gotten taller. She can wear 12 month pants now but, although they fit in the waist, they are capris! I just listed all of my cloth diapers on eBay, never got the hang of them, so no extra padding for her unfortunately.

          • KeeperOfTheBooks

            Oh, I hear ya. The pediatrician says that DD’s going to end up about 5’10”. 0_0 Best I can figure is that she’s some genetic throwback to the Scandinavian I have waaaay back there?

          • BeatriceC

            MK was weaned to formula at six months because I was pregnant again and my body couldn’t handle it. He’s now an inch shy of six feet.

            Oh! Wait! I figured it out! He’s sick now, a month shy of 15 because of the formula!

          • KeeperOfTheBooks

            Unless you want some fool on whom you can take out your stress over MK, I seriously suggest not saying this to people you don’t know well. They may actually subscribe to that theory. (If, on the other hand, you’d like a verbal punching bag, go for it, I say!)
            A relative of mine, an absolutely wonderful person and mother in her late 50s/early 60s, blames herself to this day for her daughter’s bipolar disorder because she didn’t nurse her daughter but did her other, non-bipolar kids. While I don’t know the details, it seems not unreasonable to guess that her milk may never have come in with the daughter in question, she being the oldest kid, and in any case it would have no future bearing on the kid’s brain chemistry. Nonetheless, mom honestly thinks, thanks to the lactivists, that it must be her fault that her daughter struggles as she does. Speaking of verbal punching bags, what I wouldn’t give for five minutes with the person who put that idea in Beloved Aunt’s head…

          • BeatriceC

            Good point. I’m being snarky and sarcastic. And besides, let’s say that the formula really did cause all these problems, at least the kids are alive to have them. I’m my case, had I continued nursing MK, he would have survived, but YK would not have. So breastfeeding would have killed one of my kids. Instead, formula allowed me to keep three of them. After loosing another three too early for survival, I’m ok with that.

          • KeeperOfTheBooks

            It’s almost like you have your priorities in order–keep the kids alive, and work out everything else later! Quite the opposite of the better-dead-than-autistic vibe I get from a lot of antivaxxers.
            My sympathies on the three preemies; I can only imagine. 🙁

          • Charybdis

            Mystery solved!!! Who knew formula was a time bomb? /snark

          • Daleth

            My 90-95% formula-fed twins, who self-weaned from what little breastfeeding I did when they were 4 months old, are 20 months old and three feet tall. That puts them at about the 99th-100th percentile for height. Nickee seems to think they would be even taller–that is, above the 100th percentile and thus taller than every other 20-month-old in America–if only I had breastfed.

            Oh, and they’re both at 29-30 pounds, so only about 90th or 92nd percentile for weight. Nickee, shouldn’t they be shorter and fatter since I fed them formula???

          • Bombshellrisa

            Like my combo but mostly formula fed son, who is two and a half and skinny enough for 18 month pants. Too bad they end up as high waters, he is tall. Maybe I should stop letting him play in the yard or something and make him sit still so he can gain some weight.

          • Megan

            On that note, I just got adjustable waist jeans for my daughter from Old Navy. I don’t think they make them for baby sizes but I was able to get a 2T. Haven’t tried them yet but maybe that would help you? I think Children’s Place sells adjustable waist pants too but Old Navy was cheaper. 🙂

          • Bombshellrisa

            I need to check that out. I love Old Navy!
            Someone gifted some clothes to us this week, there were adjustable waists in some of the pants! They are Levi’s and Quiksilver. A little baggy in the legs but long enough for a leggy boy!

          • An Actual Attorney

            H&M also has adjustable waist pants for toddlers. We had a bunch of those. Wish they made them for grown-ups.

          • demodocus

            we’ve got a bunch by trolling through thrift shops, so i can’t remember the brands. We also put Mr. Wiggles in overalls, though the T sizes are more awkward for diaper changes. (No more snaps below)

          • momofone

            I haven’t tried the Old Navy jeans, but had good luck for my son with the adjustable waist jeans from OshKosh. They were the only ones I could get to stay on from babyhood until he was about seven. 🙂

          • nikkilee

            Research applies to populations, not individuals. Breastfeeding is nature’s seatbelt; not a guarantee of anything, and increasing chances of healthy life, and making a hospital stay shorter. http://www.ncbi.nlm.nih.gov/pubmed/27190526

          • Heidi_storage

            Nature’s seatbelt? Er, no. It’s nature’s way of feeding the baby, that’s true. Sometimes, in the absence of good alternatives, it leads to very bad outcomes. Both my kids probably would have starved in spite of my having an excellent milk supply because they just never learned to latch. (Yes, we tried for a long time. Yes, we saw lactation consultants.) Luckily, pumping worked just fine for me, though it was a pain to do.

          • Irène Delse

            Wow, babies will have grown when they’re two? You don’t say!
            /snark

            This is ridiculous, though. You are just making the assumption that a baby can’t over eat when they’re breastfed. But mothers of twins can someone EBF… And before formula was readily available and safe, patents often had to rely on wet-nurses, women who had enough milk for their own baby and one or two more. Which should tell you something: milk production is not always perfectly tailored to an infant’s needs. Some women don’t produce enough for one, others have a lot more. It’s easy, if a woman has ample supply, and time on her hands, to use the breast to soothe baby… And get a very chubby baby as a result.

            True, babies will grow fast after that… But it’s also true of a chubby bottle-feed baby!
            Of course, using the breast as pacifier is limited in time: all babies get weaned at some point. But if bottle-feeding parents fell into the habit of giving a snack each time baby was fussy out upset, or even as something to do, this is a behaviour that can carry on after infanthood. And the bottle is blamed, out the parents, not the food-as-comforter habit.

          • guest

            Just as the vast majority of chubby FF babies, after they have been “running around” for two years, will also have become lean.

            Serious question: Why are you so stupid?

          • guest

            Wait, so if FF babies are fat, and BF babies are lean, that would mean that…combo-fed babies are JUST RIGHT!

          • The Bofa on the Sofa

            Responding to general comment, and not to yours specifically: I’ve told the story before of my niece, who was EBF and weighed 26 lbs at 6 mos. Her sister weighed 23 lbs at 6 mos. Biggest kids I’ve ever seen.

            The older one looked like “The Michelin Man,” with all the rolls on her arms and legs.

          • StephanieA

            And then there’s my obese EFF toddler. He was 20 lbs at 12 months. His doctor had him come in for a weight check at 2y3m because his weight and height percentiles were so far off. My friend has a 15 lb 11 month old. She’s formula fed.

          • Who?

            So are you now claiming to be able to pick, by just looking at them, breast v bottle fed babies at the age of 2?

            A simple yes/no answer please.

          • demodocus

            Well, Who, *REAL* breastfeeders are still feeding their 2 year olds, so it’s easy.

          • guest

            Maybe she doesn’t count them as breastfed unless they are breastmilk only until age 2. Given the malnutrition that would happen in that scenario, you might indeed be able to tell who was starving their child of solids and who was not.

          • nikkilee

            Sometimes I can, by complexion. But this is not a skill that has any value.

          • momofone

            Bull.Shit.

          • The Computer Ate My Nym

            Oh? How do you know that you can tell? If you were presented with, say, 10 babies, 5 breast and 5 formula fed, how often would you be able to tell the feeding method by looking at them? Also, I notice that you say complexion, not chubbiness or height or activity or apparent health. If chubby breast fed babies get lean at age 2 but chubby formula fed babies don’t, shouldn’t you be able to tell easily by weight or musculature?

          • MaineJen

            WOW. I call bs. What are the differences, if I may ask? *fascinated*

          • Charybdis

            By complexion? How’s that work?

            *sits with MaineJen*

          • Heidi

            If you can “sometimes,” I think you just got lucky with your guess.

          • DelphiniumFalcon

            Riiiight.

            Pop quiz!

            Two sisters, one breast fed and the other exclusively formula fed. Ages approx. two to three years old. Which one is which? Which one now struggles with adult acne and which one has nearly perfectly clear skin today?

            https://uploads.disquscdn.com/images/8e802ca183d8ff16a2dc4e9d76fc1bb0f6446dc4243a1d3e4ab2517dbd80ba92.jpg
            https://uploads.disquscdn.com/images/8f3d8a8af878e0243589a14bf6bc1f1b8a863afdb47083be19f9b1a22834ea0a.jpg

          • Who?

            DF it isn’t kind to mock the afflicted.

            Gorgeous girls, btw.

          • DelphiniumFalcon

            But…but… I wanna!!!

            And thanks lol. I’m sure people have guessed but that’s my sister and I. Can’t say who’s who yet though. Not that I think I’m getting an answer. But we were cute stinkers! I don’t know what happened to me but she has this “beauty is never tarnished” talent. She gets thrown around a mat and put in a headlock and still looks like a million bucks. I have a mildly bad day at my desk job and I look like I got hit by a truck. XD

          • Who?

            I know what you mean, I’ve been giving in to some of my baser urges above. No manmade chemicals in the garden, combined with the prolactin preview, did me in.

          • Who?

            Better than chance in the cohort? Didn’t think so.

        • The Bofa on the Sofa

          Isn’t the claim that the BF could lead to the reduction of childhood obesity predicted on the (incorrect) assumption that breastfeeding decreases obesity?

          We know now that is not true, so because that premise fails, so does the conclusion.

          • Sarah

            Yep

          • nikkilee

            Breastfeeding reduces the risk of obesity for infants and mothers. However, this benefit is diminishing because there are so many factors contributing to overweight/obesity such as inflammatory response to chemicals in food, lack of activity and lots of screen time. The studies look at populations not individuals.

          • Nick Sanders

            inflammatory response to chemicals in food

            Ooh, it’s been a while since I’ve seen inflammation woo.

          • nikkilee

            I am reading it now.

          • Amazed

            You’re reading your own posts? Good to hear.

          • Nick Sanders

            Reading what?

          • momofone

            It’s the toxins!

          • guest

            Lack of activity and lots of screen time are the same thing, as far as weight goes.

          • nikkilee

            It would seem so, but lack of activity refers to environment, where there is no place for children to run and play outdoors safely. . . this is true for parts of many major cities in the US.

          • Megan

            Sure, and the low socioeconomic status of those places might contribute to outcomes, dontcha think?

          • guest

            Yes, but they are still both about lack of activity. It doesn’t really matter whether it’s because they watch TV, or because there are no playgrounds. The TV itself does not make anyone fat.

          • MaineJen

            So what would be causing the obesity, nikkilee? Environment? Or formula feeding? Or maybe, just maybe, poverty, and lack of paid parental leave, are the issues. But they are much harder to address, aren’t they? Much easier (and more satisfying!) to browbeat poor women who must feed their babies formula because they have to be back on the job at two weeks postpartum (for example). And then continue to browbeat them throughout the years when they fail to feed their families natural, organic food, because the most logical economic choices are the foods which are cheapest and most calorie-rich.

            Think.

          • nikkilee

            You are right MaineJen. Mothering is not valued in the US. Only 25% of mothers can take advantage of FMLA, that would let them stay home with their new babies for 12 weeks. . . .without pay. Women are expected to do everything perfectly but with little or no help.

          • momofone

            Nikkilee, I’m curious about your thoughts about fathers and their role in new-baby care. What are your thoughts about paternity leave for the purpose of fathers being primary caregivers?

          • nikkilee

            A great idea. And a great idea for dads (or partners) to have leave as well. Nothing is more important than babies, who are our country’s future. Human infants need lots of tending; the burden should not be all on the mother. http://www.huffingtonpost.com/2015/06/17/best-countries-for-patern_n_7595946.html

          • MaineJen

            So we agree. The root cause of increased obesity, especially among the poor, is not the fact that mothers are giving their babies formula. It is the fact that children have no safe place to play outside, and the food they eat tends to be the cheapest and most calorie-rich, since that makes the most economic sense.

          • nikkilee

            Formula feeding is one of many reasons; formula lacks human appetite regulating hormones (obstetatin, ghrelin, leptin, adiponectin and probably more that haven’t been yet discovered). Babies fed formula or bottle-fed human milk, feel full based on volume; breastfed babies feel full based on changing fat content in the milk plus the appetite regulating hormones. Plus lack of activity. Plus eating the cheapest food full of empty calories.

          • guest

            I love how you’re imagining properties of breast milk “that haven’t been discovered yet” to support your argument. Really sells it, having to rely on imagination.

          • nikkilee

            Scientists can’t discover things until they have tests to measure them. Here’s an example. For a long time, scientists and doctors said that humans didn’t have prolactin, because they couldn’t find it with the testing of the time. Then, the electron microscope was discovered; and then, prolactin was discovered, This is true for lots of things, like discovering a new circulation system in the brain that connect to the immune system.

          • Who?

            So you knew all about prolactin, then those clever science chappies found it? How fab.

            Are you entirely serious? Or is this a mildly complex and time consuming joke? Are you about to jump out of a cake and surprise us all by not being, well, nutty?

          • Irène Delse

            You’re wildly extrapolating. Prolactin is an interesting case: it was isolated at first in non-human mammals, probably because it’s easier to harvest lots of pituitary glands from lab animals… But thanks to a little thing named evolution, biologists had every reason to think that humans also produced a hormone with similar structure, function and physiological pathways. So they kept looking for it, and indeed, they found a human prolactin.
            But it doesn’t mean “they didn’t know about it before so anything not known now is possible”! No, it means they had serious reason to hypothesise a missing piece in the puzzle. Just supposing without data that breastmilk has new unimagined powers, so elusive that they make next to no change in epidemiological surveys… Yeah, no.

          • nikkilee

            When I started working in this field, 40+ years ago, no one knew that breast milk contained stem cells, oligosaccharides, appetite regulating hormones, insulin, prolactin. . . .and much more. Research is always discovering new things; that is the point.

          • Bombshellrisa

            Seriously?
            I have one EBF child and one combo to formula fed child. Both are tall. Neither is obese or even has any spare flesh, despite the fact that I am short and curvy and always have been. Know why? Cause their formula fed daddy is a tall, slender giant and his mom’s family are all slender giants. DNA over rides again. Plus We have the privilege of being middle class, with a house and yard and nice parks and nature trails right out our door. We can safely play outside and have the time to do things like ride bikes and go to the dog park. We also have access to a house on acreage with horses we can ride. We can afford to buy fruits and vegetables all year round and both my husband and I can cook and have the time to cook meals for our family, What MaineJen said above, it’s more about privilege then simply formula vs breast milk. P.S. Without formula, I never would have been able to breastfeed at all.

          • nikkilee

            Research findings don’t apply to individuals, only populations.

          • momofone

            Then why try to apply them to individuals? If they apply to populations only, there’s no reason to push individual mothers to breastfeed.

          • nikkilee

            A population is made up of individuals. No one should be pushed.

          • momofone

            Yet they are.

          • momofone

            I understand what population is made up of. You’re talking out of both sides of your mouth here–research findings don’t apply to individuals (your exact words), but then, oh, but population is made up of individuals. So do they or don’t they apply to individuals AS individuals, and if not, why the push for breastfeeding?

          • nikkilee

            Seat belts save lives. It is encouraged for populations, and even made into law in some states. At the same time, it is not a guarantee that every individual will survive a car crash. Just boosts the odds. That is also true for breastfeeding, that it boosts the odds for a healthier life. No guarantee. If enough individuals wear seat belts or breastfeeding, the population as a whole will reap the benefit (and insurers pay out less), and most individuals will as well. For a few, it won’t.

          • Azuran

            So, since the breastfeeding rate has increased dramatically in the past few decates, I guess we should see a dramatic increase in health of the popultion.
            Why don’t you show us some evidence that US population is now healthier and that it’s related to breastmilk?

          • momofone

            Seat belts may save lives, if they work. Breastfeeding may work well for some people, if it works.

          • Azuran

            Comparing seat belts with breastfeeding is a very long stretch.
            Seat belts have very easy to see repercussion that are not limited to ‘better odd in the population’: Half of the death in car crash are people without seat belt, while only 15-20% of people don’t use them. It reduces the risk of death by half and is estimated to save 13 000 lives each years in the US alone.
            My step brother had 2 car crash, I had a car crash when I was 12 (with my father and brother), Another with my mom and my 3 sibling, My step dad had 3. My boyfriend had 1 with another passenger on board.
            No one died in any of those crash, none of us had any sequels from the crashes. If there were no seat belt, at least one of us would probably be dead or permanently disabled.

            While I defy you to point to one person who died because she was fed properly prepared formula, or someone who is stupid or obese because of formula.

          • Bombshellrisa

            So then we agree, breast milk will matter very little in the long term to a child born into a middle class family.

          • nikkilee

            Nope.

          • Azuran

            There are no appetite regulating hormones in my diet right now, so why am I not obese?
            And why would breastmilk directly from the breast have appetite regulating hormones and not expressed breastmilk?

          • nikkilee

            Because the bottle-feeding technique matters; babies tend to be overfed with a bottle, as the person holding the bottle sees a little bit left at the bottom and encouraged the baby to finish it. You are not a baby, so you regulate your own diet.

          • momofone

            Specifically how is the composition of breastmilk different when it is fed from a bottle?

          • Irène Delse

            You’re really grasping at straws, here.
            BTW, if some parents are (as you say) doing bottle feeding wrong, why don’t you simply advocate for giving them better bottle feeding information instead of harping on breast feeding? When you see someone riding a bike, you don’t stop and lecture them on the benefits of walking.

          • Azuran

            And I guess a breastfed baby will never eat more than it needs too because magic? Then why is there always that fat little pup in every litter of puppies I’ve seen who’s clearly getting more than his share?

          • FEDUP MD

            My breasts made far more than any bottle would hold (I easily pumped 10 ounces each side) and my let down far faster than any bottle. They got far more food faster than any bottle fed baby. I also had babies who gained weight EBF like rockets who didn’t slow down their weight gain until they started solids.

          • Nick Sanders

            How are those hormones making it all the way from the stomach to the bloodstream and then the appropriate receptors in the brain and peripheral nervous system quickly enough to make the baby feel full before it overeats?

            And what evidence do you have that a change in fat content signals fullness?

          • Bombshellrisa

            I thought stomach acids destroyed everything.

          • Nick Sanders

            Well, at least for the first few months, infants have weaker stomach acids (and less acidic digestive tracks in general, hence the ban on honey for infants) so I’m willing to believe it’s possible for them to make it to the intestines for absorption until shown otherwise.

          • fiftyfifty1

            “Formula feeding is one of many reasons”

            The formula group actually had LESS obesity than the breast group in the high quality randomized, controlled Belarus PROBIT study.

          • Amazed

            Belarus… PROBIT… Heard of that, right? Or perhaps not since you only want to hear that breasfed equals reduced obesity risk?

          • Irène Delse

            If you get “inflammation” after eating food, you might want to throw it away, it’s contaminated with bacteria. I’d change stores, if I were you.

          • Monkey Professor for a Head

            I likely had undiagnosed coeliacs disease for years, so I genuinely was getting an inflammatory response to food. I have never been overweight.

          • Irène Delse

            That’s not fun.

            And another way that correlation is not causation. Obesity has been shown to promote inflammation, but not the other way round.

          • The Bofa on the Sofa

            In fact, an “inflammatory response” to food would, I would think, cause one to be underweight, because it is lead one to not eat as much.

            Nikkilee, of course, does not know the difference between inflammation and fat.

          • Box of Salt

            oh, nikkilee! “chemicals in food”

            Find me a food without chemicals.

          • nikkilee

            Let me be more precise. All food contains chemicals. Food out of your garden or organic food doesn’t (or shouldn’t) contain man-made chemicals.

          • Who?

            Oh that is just hilarious. All that virgin soil in your backyard, that the rain doesn’t fall on, the air doesn’t blow across.

            And those wonderful, natural chemicals.

            If your reasoning skills are an advertisement for their efficacy, I’ll stick with what’s in the packet, thanks all the same.

          • Bombshellrisa

            And no animal has ever pooped on it, ever. No birds carry anything onto it. No mole has ever burrowed under it, spreading dirt from your chemical loving neighbors.

          • Irène Delse

            You’re quoting the definition of organic agriculture, not defining any standard of safety or quality. And organic agriculture does employ toxic chemicals as pesticides. Heard of copper sulfate? Pyrethrin? Azadirachtin?
            Because they aren’t man-made doesn’t mean they should be in our food!

          • fiftyfifty1

            “Breastfeeding reduces the risk of obesity for infants”

            Actually this is only seen with uncontrolled studies. It’s due to confounding. Well controlled studies prove that formula feeding does NOT cause overweight/obesity. For example, the randomized controlled Belarus PROBIT study showed that overweight/obesity were actually statistically significantly MORE common in the BREASTFED group.

          • nikkilee

            http://www.nature.com/ijo/journal/v28/n10/full/0802758a.html Formula feeding does not cause obesity; it is a factor increasing risk.

          • fiftyfifty1

            Yes indeed Nikkilee, that meta-analysis was done in 2004 and showed an *association*, but none of the studies it included was a randomized, controlled, prospective study and the authors acknowledged concerns about confounding. Since this paper was published, research groups have created study designs that would eliminate confounding. The Belarus PROBIT study did so by adopting a prospective randomized control study design. It was a huge, well desined study and it showed that the BREASTfeeding group actually had MORE obesity. In addition, well done discordant sib studies have found no difference in obesity.

            So Nikkilee, why do you keep coming back to a 2004 paper based on weak research? Is it because you haven’t kept up with the breastfeeding literature? Or is it because newer, better designed studies don’t say what you want them to?

          • nikkilee

            The PROBIT study is the only prospective study of which I am aware. It isn’t ethical to randomly assign a group to a feeding method. Hence the value of case-control and other research methods. Most the babies in the PROBIT study were breastfed; the research divided the country in half. Half the hospitals implemented BabyFriendly practices, and half didn’t. That was the intervention; showing that hospital practices increased breastfeeding rates in a country where babies mostly all started out breastfeeding.

          • fiftyfifty1

            No, Belarus was chosen because it had a LOW baseline rate of breastfeeding and didn’t already promote breastfeeding. That was why they were able to get increased rates in the intervention hospitals, because baselines started so very low. It was the exact opposite situation from that of wealthy Western countries where the breastfeeding promotion message has saturated the market audience many times over and BFHI tactics are far over into diminishing returns territory.

            But back to the point, what do you make of the fact that overweight/obesity rates were HIGHER in the breastfed group? And that obesity rates were the same in the excellent 2014 discordant sib study? Don’t you think we should be reassuring mothers that the best quality studies we have prove that formula feeding does NOT cause obesity? Why do you choose to continue to tell mothers that it does?

          • Megan

            I’m sure it has nothing at all to do with the fact that nikkilee’s income is totally dependent on getting moms to breastfeed… /s

    • Mac Sherbert

      When you’ve had a csection or just a very ruff vb and can’t get in or out of bed, when you can’t get the baby out of the bassinet from your bed, when there is no one to bring the baby to you…rooming in will turn in to bed sharing. There’s no other solution to a mother in that position if a well baby nursery is not available.

      There must be evidence some where because the last time I gave birth my hospital room was covered with signs that said if the nurse finds you asleep with the baby in bed with you the baby would be taken to the nursery! Those signs were not there the first time I gave birth. Something happened that caused them to put up those signs and have that policy.

    • trashpanda

      Hey, Ms Reading Illiterate, babies are dying not because mom is bedsharing, but she’s attempting to breastfeed and passes out.

  • Margo

    I would like to share with you all that as a midwife working on a BFI unit I found the steps that had to be followed come what may intolerable and was one of the reasons that in the end, taking a selfish step, to preserve my sanity, I walked away from the unit and went into the community to work, where there was a more sensible approach to the who.e business of feeding a baby. The stress for new mums put under pressure to fulfil a hospital’s ideal was cruel to say the least, and also hard for those staff who had previously worked under more compassionate ideals. I have said it before and will say it again, when new mums were nurtured with great food, good staffing levels, nurseries and a communal dining room where mums could have meaningful helpful dialogue with other mums, it seemed to work really well for all involved. Mums went home after two or three, four days, as rested as possible, either bottle feeding or breastfeeding, feeling fairly confident…..it was a system that worked pretty well…..and then we broke it.

  • Irène Delse

    It’s horrible to think that the only thing that may urge hospitals to change is lawsuits by parents whose baby got injured or died because of these policies.

    • CSN0116

      What’s the saying?

      “Never underestimate the power of a few committed people to change the world. Indeed, it is the only thing that ever has.”

      Regarding medicine: “Never underestimate the power of a few massive lawsuits, with dead babies and lots of emotion attached, to change practice guidelines. Indeed, it is the only thing that ever has.” 😉

    • EmbraceYourInnerCrone

      Complaints from lots of parents, in writing might help but individually people don’t think of it and are usually to tired, stressed, etc to do it at the time.

  • SF Mom & Psychologist

    I’ll share a piece of anecdata that seemed like good news on this front … I got together with a friend last night; her second baby is 1 month old. She struggled with breastfeeding her first child but stuck with it in spite of nipples that were cracked and bleeding for the entire 9 months she breastfed (she believed the woo). The same thing appears to be happening this time with #2, and the LC at her hospital told her:
    1. There is no significant benefit to your baby for you to continue.
    2. Pick and end date and quit.
    I suppose it helped her cause that when the LC was observing her nurse, she started actively bleeding (through the nipple shield) and the baby had mom’s blood all over her mouth. What an image!

    • CSN0116

      OMG no way would I ever continue, not even for five minutes. Bye Felecia! Thank God your friend got a sensible LC!

      Unrelated, my mom has this “friend” who just had her third baby girl. Baby is about two months old now and so addicted to mom’s boob (and mom is addicted to baby being addicted to her) that she said today, “Screw it, I can’t take ‘Sarah’ to preschool anymore! All the baby does is scream the entire trip.” Mind you, the preschool is 0.5 miles away and drop off is mere minutes. My mom asked what she was going to do to get the little girl to preschool because all of the end-of-year festivities and graduation are coming up (plus she has paid the tuition). She just told my mom that she doesn’t care and the little girl will get over it; she’s not going back because she can’t handle the struggle of forcing the baby to be off her boob for 5-7 minutes worth of a drive and drop off. There is nobody else to do the drop off/pick up so the kid is just quitting school about 6 weeks early for the sake of the newborn and the boob. Fucking ludicrous.

      • Megan

        That’s terrible! I would never deny my kid the joy of going to her “school” (daycare). She loves it so much and loves to see her friends, even at her young age. I’m sure those older kids are already dealing with the adjustment of having a new sibling. It’s so sad to take something of normalcy away from them.

        • CSN0116

          This is the same hysterical woman who makes her baby sleep on that mat that detects if the infant stops breathing AND attaches an anklet to detect if the infant stops breathing.

          When I asked her what she planned to do if the infant, in fact, stops breathing, she told me she’d call 911. The dumb shit spent hundreds on monitors and has no infant CPR training. #genius

          • An Actual Attorney

            Sounds actually like it might be ppd and anxiety that are making it hard to function. Current culture then gives her both positive feedback and a screen to keep anyone else from noticing how out of whack she is.

          • That’s an insightful and scary thought. The oxytocin from having the baby either latched on or using her as a pacifier could take the edge off her anxiety.

          • Or the baby isn’t getting much food out. Hmm.

          • prolifefeminist

            Hmm… Interesting thought. Either way, so not healthy.

          • An Actual Attorney

            No, not healthy at all. I just know that with the current Actual Baby, I had ppd (treated now with medication and attention to getting enough sleep). I definitely could have said to hell with getting older Actual Kid to school. It was just one more thing I had to manage. But since he’s old enough for mandatory school, if he is even late more than a few times, we would get referred to CPS.

            Also, my ped said that after 15 minutes on a side, babies burn more calories than they can be possibly talking in, so after 30 minutes total, it was good to move to formula.

        • prolifefeminist

          My youngest is in preschool (aka daycare), and he loves it. LOVES it. Has all his little friends and is so happy there, and comes home to a mom who’s fulfilled and happy because she gets to work a job she enjoys and go to school to learn what she loves. The thought of just yanking that away from a child is just abhorrent. What the hell is wrong with people?

      • Who?

        Setting those kids up for some full on sibling rivalry. So unfair to the older one.

        • The Computer Ate My Nym

          Not great for the younger one either. What’s going to happen when she’s weaned and no longer the center of her mother’s world? Will the mother notice if the older child bullies the younger in retaliation? Or will she be on to a new baby by then and have lost interest in the older child?

          • Sarah

            She’s not going to be weaned. Don’t be ridiculous.

          • Who?

            It did cross my mind to wonder whether the older one might still be having a taste, or maybe very recently stopped.

      • BeatriceC

        I feel really sorry for the older girl. I wonder how many years of therapy it will take her to get over being an afterthought to her younger sibling’s breastfeeding “needs”.

      • DelphiniumFalcon

        Anyone else getting images of Lysa Arryn in a few years if something doesn’t change?

      • prolifefeminist

        Um…what the fuck fuck fuckity fuck?? As the adult child of a woman who thought like this, that the breast supersedes all else, this makes my blood boil. Humans – all humans – have needs. Not just the breastfed ones.

      • Allie P

        What does she do with her preschool child all day?

        • CSN0116

          Well, when my mom stopped by the other day the preschooler was on her iPad for over 4 hours straight.

  • RNMeg

    This push to BF at all costs doesn’t stop after discharge, by the way. I was admitted to my hospital about 4 weeks postpartum for acute cholecystitis, and had surgery. Postop I was on antibiotics that are contraindicated in breastfeeding, and per my surgeons recommendation, I pumped and dumped and my husband formula fed for the duration. The LC visited me every day with increasingly urgent instructions to breastfeed anyway. Apparently she even had a neonatologist call my surgeon to discuss the situation. I felt bad for my surgeon; he was concerned about my baby and I appreciated that. I didn’t even ask to see an LC, my nurse contacted the lactation department without asking me first.

    • PeggySue

      HO.LEE.CRAP. As I posted about something else, “What about ‘scope of practice’ do these people not understand???”

      • Nick Sanders

        I’d say that goes beyond “practicing outside scope” and into “invasion of privacy”.

    • Anne Catherine

      oh my, that is pretty bad..

    • BeatriceC

      In contrast, I was readmitted after my third for double pneumonia, and was on strong antibiotics contraindicated for breastfeeding, and they were totally supportive of any option I chose. They’d help me “pump and dump”, or they’d help me dry up if I decided I didn’t have it in me to keep going. Youngest Kid was still in NICU and fed exclusively pumped breastmilk, so I decided on a minimal pumping schedule (and still seriously overproduced) just so production wouldn’t stop. I figured I had enough saved that I could continue to feed him for quite some time on just what I already had, and would probably get my supply back up to at least just what he needed if my production slowed down. It didn’t. But I was glad the hospital staff were supportive in whatever choice I made.

    • Young CC Prof

      Come on, breastfeed even on antibiotics! Never mind any potential toxic effects on newborns! I mean, everyone knows formula wrecks the baby’s microbiome, and breast milk….

      Oops.

    • Allie P

      I got calls from THREE — THREE! — LCs after delivery (hospital, OB, pedi), all who gave me grief over supplementing.

  • RN

    All of these examples in this article absolutely happen in BFH. Our hospital has just started the agonizing and ridiculous journey to become a BFH. Our care has gone downhill significantly since our journey started. We’ve had a lactation consultant (who isn’t even an RN) go against what a neonatologist said to do for a feeding for a critical situation. It’s ridiculous! Our LCs who are RNs are great, and have the medical knowledge to not advise mothers to do dangerous things. Of course, the RNs report every one of these incidents to our managers. And they get a talking to. But, the LCs don’t care. They truly believe this sketchy research that backs the BFHI that was done in the early 1990’s. They truly believe that they are right, and that thry have the knowledge to advise mothers on at risks kids. None of our RNs, Docs, or managers buy this BF stuff. And I can tell you that we are ALL pro-breastfeeding. We just also recognize that not all babies tolerate the first few days to week that it takes for a mom’s milk to come in. We recognize that not all moms will produce enough milk (LCs ignore this fact). And we also recognize that our moms have a choice not to breastfeed. Our LCs try to guilt our moms into breastfeeding. It is getting very dangerous in my opinion. Our upper managers (not our nursing managers or chief docs) are the ones MAKING us go Baby-Friendly! Please, patients start complaining! I don’t think this will stop until the hospitals realize that our moms don’t want this type of bullying for postpartum care! We have no control but to keep fighting back against our LC’s inappropriate behavior. We’re going Baby-Friendly whether any of us want to or not! Thanks LCs! Please help us fight back, patients! If you feel bullied, mistreated, or offended by your postpartum care, PLEASE write to the CEO of the hospital AND the nurse managers! Heck, even include a letter to the LACTATION department and tell them how you felt too. This is the ONLY way these lactivists will WAKE UP and stop the insanity!

    • demodocus

      I was generous when the surveyor came along and told her that I had a personality clash with the LC. (Probably because the LC came across as pushy and arrogant.) and at that time I wanted to bf!

      • demodocus

        She was easily the most arrogant person I’ve ever met in the healthcare.

    • Are you nuts

      Unfortunately, I think a lot of this is a marketing problem. Before I understood what this meant, I wanted to give birth at a baby friendly hospital. I figured it meant I would have access to a lactation consultant and whatever else you need to start breastfeeding.

    • Can’t fool me twice

      Already done! I got the inappropriate LC at the hospital where I delivered fired. I wasn’t the first mom to complain, but my strongly-worded complaint was the final nail in the coffin. When I had my second, I turned down the offer to see the new LC, and since it wasn’t my first rodeo, my nurses were happy to leave me to it. You bet I also sent #2 to the night nursery and requested to see only see that one if it was either hungry, or if the sun was up. Otherwise nope. We were breastfeeding dynamos, too. BFI had NOTHING to do with it. The good night’s sleep, on the other hand, was indispensable.

      • RN

        Good for you! I wish more patients would speak out. I can think of COUNTLESS inappropriate encounters one of our LCs has had with patients!

        • Can’t fool me twice

          It was truly my pleasure! My strong complaints about that LC were bookended by my strong praise for the wonderful nursing care I received. That hospital is only sorta “baby-friendly.” They still offer pacifiers and formula, will happily take your baby when needed, and aren’t dogmatic about pushing breastfeeding (which they fully support). Perhaps that’s why my complaint was taken so seriously?

          They also prided themselves at having a years-long streak of no mother falling. In hindsight, it seems they were unusually supportive in maternal choice, and just support in general. Go figure, and lucky me!

  • Chrisp

    I appreciate this post very much. I delivered my daughter in December 2014 in a baby friendly hospital. In the two days I was there, the nurses took her once—-for one hour—. Needless to say, I did not rest at all. If you are a mother who wants to room in – by all means, do so. But it would have been nice if there was some place for her to go so that I could sleep for longer than 30 minutes at a time. I also know that hospitals are getting rid of nurseries entirely, so the nurses have to roll the baby around the nurses’ station. This is just idiotic. Hospitals make a lot of money off their maternity patients – hence the three room suites. They should reinvest that money back in nurses and nurseries. It sucks because the nurses have completely stepped back from actual OB nursing. It’s been taken over by non-medical staff, all because of the baby friendly initiative. And please let us now overlook the issue that if men delivered babies, this would not even be a discussion. Call it what you want, but it’s hard to view all this forced breastfeeding/rooming in nonsense as anything but discrimination against women.

  • Chi

    If the BFHI is about ‘saving money’ have they factored in the cost of babies readmitted for dehydration?

    How about the long-term cost of caring for a child brain damaged from dehydration?

    Or the cost of a funeral for a baby who smothered in their mother’s hospital bed, or got a bleed on the brain from being dropped?

    I think parents need to start suing hospitals when things like that happen. Expecting new mothers, exhausted, possibly doped up on meds to have pretty much sole responsibility for the care of their newborn when they are BOTH supposed to be patients, when there are supposed to be nurses there to HELP is utterly ridiculous.

    What the hell are they paying the postnatal nurses for? Other than giving lectures on the miracles of breastmilk and filling out paperwork?

    • KeeperOfTheBooks

      Cynical me says you betcha some hospital administrators have factored in the cost of babies readmitted for dehydration, and they see it as a win-win situation. Lower cost initially due to fewer staff, and more profit later when babies get readmitted to the tune of several grand apiece!

      • Azuran

        Either that or they figure that if they treat mothers like shit enough, mothers are just going to take their babies into another hospital when they get sick, so it’s not their problem.

        • KeeperOfTheBooks

          The only reason I don’t subscribe to that theory is that a lot of hospitals see OB as kind of the gateway to the family coming to that hospital for treatment for any future issues. Mom’s happy with her stay, then mom brings the kid back later on when he has a fever, mom has more babies at the hospital, dad goes there, too, ’cause that’s where everyone else goes, etc.
          The really twisted part of the BFHI is that they have the moms believe that they’re supposed to receive dreadful care because it’s better for them and baby. If a nurse says “hey, would you like to get a shower in? I can watch Junior for half an hour while you do so,” she’s “sabotaging the breastfeeding relationship.” If a nurse says “you’ve fallen asleep twice during this conversation, and spent the last 2 days laboring. Baby just ate, so want to sleep for a couple of hours while I watch him?” she’s preventing you from bonding. Nurse says, “You sound like you’re in a lot of pain; would you like me to discuss pain relief options with you, or would you prefer to wait or go without?” she’s “forcing you into an epidural.” Etc.

          • PeggySue

            The problem I have seen is that, in some places, nurses are very smart and doctors are very smart. But they are told what to do by marketers and accountants. And manager who may be RNs but have not done floor nursing.

          • KeeperOfTheBooks

            Very true, that.

          • Charybdis

            I have often wondered about that sort of thing. How do people who have not attended medical school ( I’m including nursing and physician’s assistant schools in this) get to dictate to those who have how to do their jobs?

            We sure as hell don’t tell the accountants and marketers how to do their jobs and they wouldn’t stand for it if we tried.

          • Guest

            I would say you’re right about treatment during delivery influencing ER/hospital choice later. My daughter has had some minor issues requiring ER and specialty scans, and even though I wasn’t 100% happy with my treatment, I chose the hospital I delivered in because I knew it and it felt more comfortable than an unknown (and my issues didn’t have anything to do with the medical care side, but rather the nursing/recovery side). So I took her back there (and in my judgement there did very well. The technician who did her kidney ultrasound clearly had experience minimizing fear in young children, and they have a separate pediatric ER).

            Unless they screw up in a big way, it’s unlikely that I’ll go anywhere else unless I have to – and in a big city, we do have a lot of choices. This probably doesn’t matter as much in areas where there’s really only one hospital a reasonable distance away, though.

      • PeggySue

        Public opinion–patient satisfaction is HUGE these days when hospitals have marketing departments that compete. Hit them in the Press Ganey scores, make their patient reps’ lives hell, go on the news, make this look like the disaster it is.

        • BeatriceC

          My only problem with this is that it’s the doctors and nurses that suffer as a result of those bad reviews. The hospital never takes the blame for bad policies, but will fire/reduce pay for the doctors and nurses who have no choice but to follow the directives of their administrations. Until they get their heads out of their asses on this point, I actually refuse to fill out those surveys and find other routes to complain.

          • PeggySue

            You’re right, of course, and I should have thought of that. Line staff can easily be fired, because we are thought of as just pegs that go in holes. I have heard of line staff being pressured to sign complaint reports that are completely untrue so that their manager can show that “action was taken” on a complaint.

          • RN

            Write letters! If you want to fill out the Press Ganey Surveys, you can leave comments. If your hospital still has a nursery and doesn’t shame you into keeping your baby, thank them for continuing to have a nursery when so many hospitals are forcing rooming in! If you’ve been forced to room in due to no nursery or the BFHI, you can blame the BFHI, not the nurses for your dissatisfaction! The more you mention the BFHI in relation to the care you received (ex no pacifier available to you and your screaming baby due to the hospital being BF), the better! And please, complain about the LCs that made you feel like bad mothers or bullied you! There are way too many LCs with no real newborn or postpartum mother education! Any idiot can become an LC now. It used to be just RNs not that long ago. If you’re a mom that loved breastfeeding and thinks moms that bottle feed are horrible moms, pass the test, put in hrs, you can become an LC too!

          • The Computer Ate My Nym

            When I get a PG survey, I circle the highest rating for everything and then in the comments section write: “Since I know that the PG score is really a mechanism for insurers to deny payment, not to improve quality of care, I gave you a perfect score to avoid that. Now, here’s what I really think…” And proceed to fill in what I think was really good and where I think they could improve. I don’t know if this gets read or not or if they just think I’m a crank, but it’s the best I can do under the circumstances.

          • AllieFoyle

            Oh, it gets read alright, and it isn’t anonymous. Ask me how I know…

          • BeatriceC

            I tend to file complaints with the hospital directly, my insurance company, and the state governing agency if I have a problem. I got an ER nurse fired last year that way. I was readmitted post-appendectomy for uncontrollable vomiting and while we were waiting for my bed upstairs he withheld anti-nausea meds and pain meds until I used my cell phone to call the patient advocate from the ER. That got things moving.

        • Busbus

          It’s true. Someone I know got Kroger to respond within a few hours when he posted his complaint on Twitter (after trying for weeks to get it taken care of in other ways; it’s a personal story, but he had good reasons to be very upset).

          Maybe that’s what people need to do – hit the hospitals where it hurts: their reputation. If with these types of awful stories, mothers were posting them publicly, urging others not to use this hospital’s maternity services, I bet that would get administrators to think, and fast.

  • sdsures

    I just took a gander at the website for the maternity unit of my local hospital (I’m in England.). There in black and white screams “promote normal and natural birth”. They don’t use the phrase “BFHI”.

    *facedesk*

    • Megan

      My CS was the normal and natural way to prevent complications for me and my baby.

    • LaMont

      To quote King George, “Awesome! Wow!” (I’m way too involved with theater people and it’s All Hamilton All The Time up in here. To those not familiar with the show, rest assured this is sarcastic.)

    • Erin

      Slightly irrelevant but I was thinking today as I read looked at facebook instead of studying, the sheer number of women in the vbac group I’m in (don’t ask) who end up with repeat sections for the same reason as the primary one. I’d say conservatively it’s about fifty percent, possibly higher. Natural has a lot to answer for.

    • guest

      Oh yeah, promote the shit out that normal and natural pre-eclampsia!

      • sdsures

        *massive shudder*

    • MaineJen

      Uuuuuugh I would run from that hospital as fast as I could…I loved my unnatural epidural!

  • Tamara

    I am shocked by this article; I find it extremist and alarmist. NO ONE is advocating a one-size-fits-all solution, however impoving rates of breastfeeding (both initiation and maintainance) as well as facilitating physiological attachment are laudable and important goals.
    If a woman’s goal is to exclusively breastfeed, she should be supported to do so. Rooming in (which is NOT the same thing as bedsharing) is an important aspect of it. Brainlessly initiating formula feeding when there is no indication to do so will certainly reduce milk supply.
    Is there a place for formula feeding? Of course. Is there a role for medical intervention? Certainly. But STOP with these misleading posts. This does a major disservice to new moms who already have so much to be anxious about.

    Sincerely,
    Another MD

    • The Bofa on the Sofa

      “Brainlessly”

      You really have no respect for women, do you?

      • LaMont

        I mean, today I “brainlessly” ate lunch earlier. Didn’t think much of it. No medical reason to do so, I could safely skip a meal and am in no danger of starving – heck I’d even fit slightly more comfortably into my clothes if I dropped a few pounds. But I ate anyway. Seriously, why do people act as though giving formula is akin to popping dangerous medication without a need when it’s just freaking *food*!!

    • MaineJen

      Read down into the comments section, and you will hear from real women who have experienced these BFHI policies. There may be good intentions, but often the execution is overzealous.

      • The Bofa on the Sofa

        But see, Jen, most women that Dr Tamara talks to don’t mind, so the bad experiences of those below don’t count.

    • Megan

      Can you show us any evidence that the BFHI increases breastfeeding maintenance? If you can, I’d be interested to see it.

      Signed,
      A Fellow Physician (and mother who apparently “brainlessly” started formula)

    • moto_librarian

      How wonderful to see a MD mindlessly parroting the usual lactivist talking points! Are you actually unaware of the study demonstrating that supplementation can improve long-term breastfeeding success? And are you actually going to talk about breastfeeding and “physiologic” attachment when there is absolutely zero evidence that breastfeeding has any role whatsoever in bonding?

      I think that we all know that rooming in isn’t supposed to be about bed sharing, but when you expect an exhausted woman, quite possibly on painkillers, to care for an infant, she will sometimes fall asleep with that baby in her bed. Since pacifiers are verboten as a means to soothe a baby in a BFHI hospital (and forget about asking for the F word), the advice given by far too many lactation professionals is simply to keep the baby attached to the breasts. How exactly is this appropriate care for mothers or babies?

      Last time I checked, newborns are patients until discharge. Why are they not being cared for as patients in so many hospitals? Why are they not given appropriate care in a nursery and food for hungry tummies? Why do so many supposed professionals fail to tell new mothers that up to 44% of primips will have delayed milk production, or even that 5-15% of us will never make enough milk no matter what? Given that the majority of women in the U.S. work, why is combo feeding not discussed as a matter of course?

      Dr. Amy isn’t the problem here. Failing to treat mothers and babies as patients is the problem. Failing to give women accurate information about the minimal benefits of breastfeeding a term infant in the developed world is a problem. You are the one doing a disservice to your patients.

      • Chi

        Bravo. You said that far more eloquently (and politely) than I could.

        • moto_librarian

          I dealt with a real peach of a LC (might have been a IBCLC) after my first delivery. I was in the NICU, visiting my son for the first time since he was born, still in a wheelchair due to pain and weakness from the blood loss. She wanted me to try nursing him, and she was a royal bitch about it. Bear in mind that I wanted to breastfeed, and had read The Nursing Mother’s Companion in preparation. Well, reading and looking at illustrations is of little help when you’re actually trying to latch a tiny baby to your breast for the first time. Rather than giving me helpful information or encouragement, she told me that I was doing everything wrong, and then proceeded to grab my breast without asking so she could twist it into the appropriate position for my son to latch. To this day, I regret that I was not in a position to advocate for myself. It’s probably fortunate for that LC that my husband was out talking to his boss in the hallway, because had he been there, he would have told her where she could go. When she visited me later in my room, she recommended pumping every two hours to stimulate my supply, as well as nursing on demand. Our son was being given formula in the NICU since he was being treated for TTN and possible infection. I went home following this regime from hell, never getting more than 1/2 an ounce after pumping from each breast for 10-15 minutes. Our son would scream in anger and hunger when I tried to put him to my breast, and I began to dread attempting to feed him. I was not sleeping much at all because I was riddled with anxiety about my inability to get nursing established, plus I was constantly up to pump, clean pump parts, and then clean bottles from supplementing. I felt like I was losing my mind, and it took my mother to finally talk me down and get me to just feed him formula.

          Imagine my anger when I began to learn just how overblown the benefits of breastfeeding actually are for term babies (my son was born at 38 + 3, so not a preemie). I was particularly pissed to learn that he would not get immunity to H1N1 from my breastmilk (he was born at the height of the H1N1 epidemic, and I was sure he was going to contract it because he wouldn’t be able to get antibodies from me once I got vaccinated after his birth). This still makes me upset, and he’s almost 7 years old.

          When our second son was born, the hospital was in the early stages of BFHI, so no pacifiers, but fortunately, still a newborn nursery. The nurses always brought him to me during the night to nurse, but I was able to get some uninterrupted sleep. I was also fairly firm with the IBCLC. After our baby had been latched on for over an hour and was still rooting around, I explained that I had primary lactation failure after my first delivery, and she recommended supplementing. She said that any breast milk was good, but formula was fine too. When my milk failed to come in again, I had no problems giving up nursing and switching to bottles.

          • swbarnes2

            Related question, is there any evidence that pumping in those first couple of days improves supply? If you are waiting for the hormone levels to drop in response to the loss of the placenta, is stimulating the breast with pumping helping that along?

          • moto_librarian

            There probably isn’t any evidence that it helps. And if there isn’t, we need to make sure that other new moms don’t put themselves through this needlessly.

          • RNMeg

            Anecdotally, pumping or not pumping made no difference in my milk coming in. With my firstborn, I attempted and failed breastfeeding (and also refused to supplement on the advice of a terrible LC) and instead starting pumping on I think day 2. My milk came in on day 3 with her, and she finally got a decent meal. She never latched, I think because of an oral aversion or pain from having to suck so hard to breastfeed. With my son (almost 7 weeks old now!) we supplemented formula from day 1 and I never pumped. Milk still came in like a dam bursting on day 3. He’s now 95% breast fed, and only gets formula or pumped milk when I feel like taking a break.

          • Megan

            My milk actually came in better faster with my second baby, no pumping, just nursing. Granted, second babies milk usually comes in faster, but not pumping certainly didn’t have a negative effect.

          • Mac Sherbert

            Both of mine were csections. First baby was a barracuda and nursed 24/7 from the moment I first held him. Milk came in five days. 2nd baby did not want to wake up to nurse. Could not get her to nurse. LC had me supplement with formula to get her to wake up. She also had me to pump after very feeding…but I didn’t pump after five pm. Milk came in 4 days.

          • Monkey Professor for a Head

            I don’t know about pumping, but I’d be interested to see the effect of adequate vs inadequate rest and food on supply. I wouldn’t be surprised if over enthusiastic pumping regimes could have a negative effect.

          • Roadstergal

            That’s an excellent point. Chronic stress and lack of sleep negatively impact a lot of bodily functions.

          • guest

            I’d like to see the evidence. My personal experience supports it, but as always, anecdotes don’t prove anything. But the hospital LC gave me an intense pumping regime while my babies were in the NICU, and I ended up with painful oversupply. But the things is, I could immediately see the pumping working to increase my output with each pumping session. My guess is that if you’re not seeing an increase day after day, continuing is highly unlikely to change things. It’s probably true for a certain set of women, but not for all.

          • nikkilee

            In the first few days, hand expression improves supply. As there has been milk in the breast since the middle of pregnancy, dropping hormone levels will boost supply whether milk is removed or not. Witness the mother who has to go through drying up her milk when she chooses not to breastfeed. Mothers who hand express in addition to breastfeeding can have their milk volume increased (aka “milk coming in”) by 36 hours postpartum. This is a regular occurrence at a local BabyFriendly hospital, Lancaster General in PA.

          • Amy Tuteur, MD

            Citations for those claims, please.

          • MI Dawn

            You couldn’t have paid me to do that. I nursed my baby, offered a bit of water or formula after that. Taking the time when I was so tired to hand express after nursing on demand? Forget it. My milk still was in less than 24 hours postpartum, but I wasn’t the norm.

          • nikkilee

            Arch Dis Child Fetal Neonatal Ed 2012;97:F18−F23. doi:10.1136/F18 adc.2010.209213 “Randomised trial comparing hand expression with
            breast pumping for mothers of term newborns feeding poorly” by Flaherman et al. is one. As for the reports from Lancaster General, the Chief of Pediatrics there told this to a BabyFriendly Taskforce, also reporting that rates of physiologic jaundice and hypoglycemia were virtually nil since Baby Friendly practices were implemented. Dr. Barbara Philipp at Boston Medical Center told a story about this too, in that she couldn’t find any babies with physiologic jaundice for her residents to care for because Baby Friendly practices were implemented.

          • guest

            SOME women can. Others clearly cannot.

      • nikkilee

        The study demonstrating that formula improved breastfeeding was a) one study, and b) full of flaws. It was a launch for the Similac product marketed to breastfeeding mothers; that launch occurred the week after publication. One of the authors of that study disclosed work with several formula companies. Read it.

        • MI Dawn

          And do you have any proof that formula negatively impacts breastfeeding? In all my years as a maternal-child nurse and midwife, I never saw that problem.

          • nikkilee

            No. However, formula use does negatively impact milk supply. . . unless mom is removing milk as often as she is giving formula.

          • Charybdis

            Not if she is supplementing in the first few days until her milk comes in. And what if her milk NEVER comes in, or comes in in an amount that is not sufficient for her baby? Or due to IGT or breast reduction she doesn’t produce milk at all?

          • MI Dawn

            So what’s wrong with offering a bit of formula after nursing? The breasts are being stimulated, but if there isn’t much milk there, the baby still needs calories somehow. I’d rather prevent excessive weight loss, dehydration, and problems with jaundice, thank you. (And yes, I was a “cow” and never needed to supplement unless I wanted to).

          • nikkilee

            Because newborns don’t need a lot of volume in the first day or two of life. Their stomach on day one holds the average of a teaspoon.

          • Azuran

            But if the mother doesn’t have milk yet it doesn’t matter that the stomach can hold 1 or 10 teaspoon. Baby is still starving.

          • nikkilee

            Milk starts being made in the middle of pregnancy, under the influence of placental hormones. From then on, moms always have milk. . . While there are exceptions, for the vast majority, this is true. First milk is colostrum. “Colostrum (known colloquially as beestings,[1] bisnings[2] or first milk) is a form of milk produced by the mammary glands of mammals (including humans) in late pregnancy.” Definition from Wikipedia.

          • Irène Delse

            Have you any familiarity with human physiology? Apart from copy-pasting uncritically.
            A delay in milk coming in is the norm. Try reading a few testimonies on this page, and many others on this blog, to see that women often don’t have enough milk, or colostrum, in the first days after birth. Some women even don’t have any colostrum!
            You’re reassuring yourself that the “vast majority” can feed their baby to satiety with just their breast milk… But it’s simply not true. Most women need a few days to get their milk production established. And even if it was only a minority, do you advise that those babies go hungry? Infants can die of dehydration…

          • momofone

            “…for the vast majority, this is true.”

            Unless it isn’t.

          • demodocus

            THanks for the lesson, I’m sure none of us have heard of colostrum. My kid lost 12% his weight in 2 1/2 days with nothing but colostrum. Apparently, although I eventually made enough for twins, I did NOT make enough those first several days.

          • nikkilee

            Was he nursing at timed intervals? Did he have unrestricted access to the breast? Was he nursing at least 8 times in 24 hours? Did you have lots of IV fluid?

          • demodocus

            Unrestricted, I wasn’t keeping count but it was certainly at least 8, and I didn’t have iv fluids.

          • Azuran

            and it is known that many women will NEVER have enough milk to properly feed a baby. And that sometimes it takes days for the milk to come in.
            In the meantime, the baby is starving.

          • nikkilee

            Follow-up is important. AAP recommends babies to be seen 2 or 3 days after hospital discharge.

          • Azuran

            And in those 2-3 days, baby is still starving.
            Why don’t you try not drinking or eating anything for 48h and tell me how you feel afterwards?
            Giving formula after each feeding in the meantime is not going to lower a mother’s supply since the baby is eating basically 100% of the breast milk anyway. It’s just not enough for him.

          • nikkilee

            I’d love to see a citation supporting what you have written. Kent in 2006 discovered that babies take about 2/3 the amount in the breast. The human race has survived 600,000 years by breastfeeding, otherwise none of us would be here. I’ve seen exclusively breastfed babies that are ounces over birthweight on Day 5 at home visits. I’ve also seen babies in trouble, and that is why the AAP recommends babies need to be seen 2 or 3 days after discharge.

          • Azuran

            I’m not sure what you are getting at. You are apparently stating that you have seen babies who are not getting enough breasmilk, so why are you opposed to formula supplementation until the milk comes in?

            Also, the argument that ‘we have survived 600 000 years’ is just stupid. Nature doesn’t do perfect, breastfeading is not perfect and it doesn’t matter to the survival of the specie that a few babies die because of lack of breastmilk. In 1960, 1 out of 4 child in Africa died before the age of 5. Today it’s still somewhere around 1/10. Yet there are still people in Africa. When women have 5-10 children in their lives, it doesn’t matter that half of them die, she still had enough babies for the specie to keep on going.
            And back in the stone age, it probably didn’t matter much that a baby had mental delay due to a lack of nutrition in the first few days of life.

          • Azuran

            Also: whether it’s 100% of the milk, 50% of the milk, 20% or 2/3rd of the milk is actually irrelevant to the point: Any % of ‘not enough’ is still not enough.

          • And if the mom isn’t producing even that much, baby loses 10%+ body weight and is at risk of jaundice and dehydration and worse. Again: what is the harm of giving a baby formula to make sure it isn’t harmed by starvation?

          • nikkilee

            Because it isn’t needed. If mom has chosen to breastfeed, 8 or more feeds in 24 hours will keep baby safe. Weight loss is often the result of baby peeing out all the fluid that it picked up in labor, from mom’s IVs.

          • You do realize that they look for wet diapers too, and often the babies that are losing weight are also not peeing (thus, the dehydration/starvation problem).

            You simply don’t get enough IV fluids to bloat yourself, let alone someone connected to you via umbilical cord, so that’s a bullshit answer. I mean, I’m not in the medical field at all and I know that’s simply not true. Where do you even pick up this nonsense?

            Some women can’t produce enough colostrum or milk for their babies, especially in the first few days. Those babies need formula or they will be very hungry and/or starve, possibly getting jaundice and possibly getting dehydrated enough to be very sick or die. Thus, just in case you are one of those women, it makes sense to bring formula with you to your birth. If you don’t need it, great! But some women will, and there’s nothing wrong with that.

          • swbarnes2

            There are mothers who lack sufficient glandular tissue, mothers who have endocrine issues and a host of other reasons that milk production can be impaired. Women can’t “choose” not to have those problems.

          • nikkilee

            True.

          • Who?

            Do you mean they aren’t hungry? In which case why do they cry and try to feed?

            Or that they have enough on board without more? In which case, why do they cry and try to feed?

          • Charybdis

            Exactly. One of the so-called reasons for mandatory rooming-in is so you can learn your baby’s hunger cues. But if they don’t count as “hungry” because of the miniscule size of their stomachs, then that argument doesn’t hold water.

            My son was bottle fed and he had absolutely NO PROBLEM stopping his eating when he was full. You couldn’t force feed him if he wasn’t hungry/didn’t want to eat. Other bottle users will tell you the same thing. Baby stops eating when they are full.

            This makes me wonder about something: if babies’ stomachs can be stretched out permanently by feeding formula or pumped breastmilk from a bottle and this will “ruin” a baby’s stomach and s/he will become an overeating, binge-eating, obese lump on the couch, then how can a woman’s vagina, perineum and pelvic floor miraculously recover instantaneously from pushing out a 6-10 pound baby (not ruined, like the newborn stomach) like the NCB/EBF crowd likes to claim?

          • swbarnes2

            Look at the tables of weight loss in this paper:

            http://pediatrics.aappublications.org/content/127/1/e171.long
            19% of formula fed babies lost >10% of their weight at day 3, 3% of formula fed babies did. Clearly, those babies are hungry. And one can be sure that the breastfed % of kids losing > 10% would have been higher had not many parents introduced formula.
            At what other stage in life do we consider it okay to barely feed a child for 3 days? Don’t you think that CPS would have words with someone who did that to an 8 year old? So why is it okay for a newborn?

          • nikkilee

            That paper is about the excess weight newborns take on as a result of mama being given IV fluids in labor, especially when pitocin is part of the labor. Many pregnant women treated this way find their ankles are more swollen at the end of the first week postpartum than they were at the end of pregnancy. As for weight loss, newborns in this paper were undergoing a diuresis. If one thinks of formula feeding as the norm, then the breastfed babies would be considered as loosing too much weight. However it was Nicolas Stettler MD who published a paper linking formula feeding of newborns and excess weight gain in the first 8 days of life to overweight in the 2nd and 3rd decades.

          • swbarnes2

            Women having harder labors will need fluids, and will have problems breastfeeding. Long, exhausting labors is the commonality here, not that babies are being born bloated. And breastfeeding leads to less obesity, why hasn’t a tripling of breastfeeding rates since the 70’s had a measurable impact? Why do sibling studies NOT show this result? Why does the PROBIT result NOT show that result?

          • nikkilee

            The amount of IV fluid a mother is given in labor is correlated with percentage of infant weight loss:

            1) Timing and amounts of maternal IV fluids are correlated with newborn weight loss.
            “Maternal average IV mL/hr positively correlated with infant maximum weight loss.”
            Clinical Lactation 2012; 3(2):59-63
            Hirth et al.

            2) Newborns have diuresis in first 24 hours.
            Accurate weight:
            Weigh newborns at 24 hours of age.
            International Breastfeeding Journal 2011,
            6:9 doi:10.1186/1746-4358-6-9
            Noel-Weiss et al.

            3) Intrapartum fluids
            “…excess weight loss was independently related to intrapartum fluid balance….”
            (over 100 cc/hour)
            Pediatrics 2011; 127:e171-179

            4).”the administration of large volumes of intravenous fluid before cesarean section may be an independent risk factor for newborn weight loss.”
            Early Weight Loss Nomograms for Exclusively Breastfed Newborns
            Flaherman, et al. Pediatrics 2014: -1532

          • nikkilee

            On the topic of obesity. . . breastfeeding does reduce risk; that is different to prevention. And, sad to say, it seems that the other factors are having an increasing impact on childhood obesity:
            http://www.cdc.gov/obesity/childhood/causes.html

          • guest

            You don’t need need more than a teaspoon of food as an adult either. But I bet you’re sure uncomfortable if you don’t get more than that, and have no idea when you might be able to.

          • nikkilee

            We are talking about stomach size. What an adult needs is different to what a baby needs. There are articles linking overfeeding with bottles as one more factor contributing to overweight/obesity in children. When infant stomachs are stretched, babies learn they have to eat more to feel full. This teaches them about overeating. You can find their abstracts easily in a PubMed search.

          • guest

            And there are articles that have debunked the “fat formula fed babies” nonsense, too. No one is forcing babies to drink more formula than they can handle. They are simply not allowing their babies to cry and starve when they don’t get enough.

          • demodocus

            If only. But then, I could pump 6 ounces off one side while kiddo had a full meal on the other.

          • momofone

            But if I don’t want to exclusively breastfeed, there’s no problem with the impact on my supply, right?

          • guest

            But, according to every LC I’ve ever met, supply rebounds as soon as you stimulate the breast again. If you believe this, it’s no big deal to supplement with formula in the early days. You can supplement until your milk comes in (if it does), and then voila! You have a jump in supply and your baby will continue to stimulate to breast to increase the amount as time goes on.

            Moms of older infants can even *GASP* skip a feeding and not see any real dip in supply. I’m unclear on why you want to scare women into constantly removing milk or else face complete lactation failure. That’s how you create an *oversupply,* which runs the risk of clogged ducts and mastitis.

          • nikkilee

            Giving formula in the first few days can set a mom up for engorgement and/or reduced supply, and/or breastfeeding challenges. The mother of the older baby, a mother with an established supply, has room to vary how she feeds.

          • swbarnes2

            Do you understand that no one is going to listen to you unless you provide citations?

            And do you you understand that most women would be happy take the tiny risk to their future supply if they lowered the risk of hospitalization for dehydration due to the baby starving for days?

    • sdsures

      Since when are preventably dead or injured babies not alarming?

    • indigosky

      You are a horrible MD and I feel sorry for your patients. I guess you think I too started formula brainlessly. I didn’t want to breastfeed, because I had yet to see any actual studies proving it was worth doing. #shitmom

      I have been following Dr. Amy, and the FFF for years. I belong to a few groups of women who have been hurt by the BFHI. I have read thousands to stories from these women. The worst case I ever heard about was a woman who had a C-Section. Her husband was deployed, and she was in a civilian hospital. The hospital refused to let her sister stay and help, it was only spouses who were allowed to stay. Exhausted, she fell asleep with the baby on her and he fell to the ground breaking his neck and was dead on the floor for HOURS. Husband had to be flown home with emergency leave. And they had tried for FIVE YEARS to have this baby, and he was now dead because of this fucking “baby-friendly” hospital shit.

      Not to mention the people who swear their children have autism from being starved for weeks and months as newborns. I personally know five moms who think this, all their babies were not getting enough to eat because they were told their babies were and not to dare and use any formula. I thought the chart showing an increase in breastfeeding and an increase of autism was funny, trying to prove correlation does not equal causation. But now, I am seriously wondering if it is not funny, but a sad truth.

      So do me a favor and get your head out of your ass and start LISTENING to women. That is what good doctors do. We are not hysterical, we are pissed that we are being treated as morons because of flimsy studies and the breastfeeding lobbyists.

      • rh1985

        That has to be one of the most horrifying things I’ve ever read on this blog. That poor family and baby. :'(

        • indigosky

          The only “good” part about that is she did end up getting pregnant and they went on to have fraternal twins. While that will never replace their firstborn, they did get to have the children they so desired. But that was after a transfer to a new unit (she had obviously developed severe PTSD) and making sure the new hospital and OB knew her story, and the command made sure her husband would be there for the birth. The hospital staff (NOT baby friendly) was phenomenal, she had a wonderful birth and her kiddos just celebrated their first birthday recently.

          • rh1985

            I really hope some policies changed at the first hospital after such a senseless, tragic loss.

      • RN

        Terrifying! This is HORRIBLE! This is why RNs HATE BFHI! If we EVER found a mom asleep with her infant, the infant went to the nursery until the next feeding for his/her safety. Even if mom wanted to room in. If she fell asleep once, she could easily fall asleep again. She’s still sleep deprived. Sleep deprived dads and other family members also fall asleep and drop babies too. The support person is JUST as exhausted! An exhausted support person should NOT be used in place of a nursery! Seriously, ONE infant death should be enough to throw BFHI out for GOOD!

      • InfiniteSovereign

        I have wondered if my son’s autism was caused by my insistence on breastfeeding with low supply. His weight gain was inadequate, my milk was like skim milk. He sat up on schedule but was behind on every milestone after that andate got his diagnosis at 3.

        • indigosky

          I know there is a strong grassroots movement of parents who seriously think lack of nutrition on their newborn’s body caused a multitude of neurological issues. And I have wondered the implication of pretty much the starvation of newborns for a long time, ever since that Dacia or whatever woman wrote an article that crying it out damages baby brains and all her crazy crap. Then I got to thinking of all the babies who cry hysterically their first weeks because they are starving, but that’s apparently OK. Between the starving and the stress of that starving, on an incredibly malleable brand new brain…I shudder to think of what is happening.

          I really wish someone would do a study of this, because it is really scary how autism went up right when breastfeed or else became the mantra of the land.

          • InfiniteSovereign

            I have been searching trying to find these mothers, but with no success. I am very intrigued (and horrified) by the idea.

        • swbarnes2

          Don’t do that to yourself. There is lots of reason to think that autism is inborn, and not affected by environmental influences, and I don’t think there’s any evidence that anything parents do or don’t do affects a kid being not neurotypical.

    • Jody Segrave-Daly

      Clearly Another MD has NEVER seen a mother suffocate her baby while breastfeeding when falling asleep after a fresh section. Clearly Another MD has never seen a baby have a seizure from hypoglycemia due to insufficient intake at the breast. Clearly Another MD has never seen a failure to thrive, exclusively breastfeeding baby that is behind in all infant milestones and not gaining weight but, everyone cheers on mom while she is harming her baby. Clearly Another MD has never seen a mom cry so hard when she learns she has been starving her baby all in the name of exclusive breastfeeding. Another MD, call me. We have things to talk about like–saving babies and mothers while promoting breastfeeding. Maybe then you will hear my panic.

    • Azuran

      I’m glad you agree that we shouldn’t try to have a ‘one size fits all’ approach. Because one size fits all is basically what the BFHI is all about.
      Rooming in is absolutely not necessary to have a healthy breastfeeding relationship. My mother breastfeed 3/4 of her kids (I was formula fed due to severe lactose intolerance) for over 6 months and we all had out own separate room at birth.
      Also, how do you suppose that supplementing a baby during the first few days until the mother’s milk come in is supposed to reduce supply? The mother doesn’t even have nay milk yet.

    • Megan

      You know, I have to add that at one point, I was like you. I parroted everything that I was told about breastfeeding because of course breast is best. Then I had my first baby. I will spare you the details but I then learned the reality of breastfeeding difficulties and how damaging the “breastfeed at all costs” mentality is. Then I began to look at the primary literature, and I mean actually read it, not just the conclusion and abstract. And I was horrified that it was mostly crap! And the stuff that wasn’t crap showed that in term babies, breastfeeding is pretty equivocal in terms of benefit. I was so angry at what I’d been taught and what I put myself and my baby through, not to mention the way I’d advised patients! I would implode you to actually read the research. You might be surprised at what you learn.

      • BeatriceC

        There’s a tiny typo there. And I got a giggle out of the thought of “Another MD” imploding. Terrible of me, I know, but I fully admit to having a morbid and screwed up sense of humor.

        • Megan

          Argh! I swear my phone tries to sabotage my efforts!! (Though maybe this one is apropos?) Ah well, my choices are post while trying to do a million other things or not post at all.

          • BeatriceC

            Your phone made me laugh. This is not a bad thing.

          • demodocus

            gave me a giggle, too

      • Anne Catherine

        This sounds kind of like my experience –the studies sure don’t match the rhetoric. I would have never worked so hard to breastfeed and would have bailed really early if I had known then what I know now.

      • demodocus

        I saw my regular ob’s partner Friday. She told me she still has to take zoloft herself even though her little guy is 8 or 9 months old. When I mentioned bf was kind of triggering for me, she said “don’t even bother, then.” I mentioned the “benefits of breastfeeding” poster behind her, and she dismissed it.
        Also, she no longer wears perfume. I’m liking her more. 🙂

    • Mac Sherbert

      I don’t know why everyone has to argue over this. It’s so simple sleep deprived, exhausted moms should not be left alone with newborns for hours at a time. There are plenty of studies on sleep deprivation. It’s not a good thing. I honestly, fail to see how a newborn in a nursery for four hours at night is going to ruin bonding and bf. I wouldn’t for me anyway.

      Rooming in is not bed sharing, but how often does it turn into that? My first screamed even at the hospital if was placed in the bassinet. My milk did not come in for days he was hungry and very unhappy. I didn’t get any rest. Thankfully my husband took extra time off work to stay with me in the hospital. I had a section and couldn’t get in and out of bed easily. Actually, I’m petite and it was not all that easy to get the baby out of his bassinet. Anyway, if woke up startled from about an hours sleep and in a fogging state tired to get the baby without actually getting out of bed. I nearly dumped him in the floor. Thank God my husband who sleeping on the couch on the other side of the bassinet woke up and grabbed it. Why I did that I don’t know to this day. I’m normally a very safe conservation person, but not in that moment.

      As for anxiety in new moms. The only thing I anxious about wAs all the never give formula or pacifiers crap. Seriously, they only thing that ever stressed me about caring for my newborns was whether or not they were hungry.

      And I’ll go with Dr. Amy can be over the top in her approach, but the woman does have a point. As you said one size fits all is not a good approach, but that may just be what baby friendly hospitals have turned into.

      • Sarah

        People have to argue with it because they don’t want to hear it, basically.

    • Margo

      But, the problem with baby friendly initiative is that there is a blanket policy re advertising, formula feeding, bottles, dummies (pacifiers), rooming in, there is no choice given. It’s the bfi way or nothing. The choice is gone. Women are sleep deprived, are left to care for their newborn pretty much on their own, whether an elective or ermengcy Caesar or vaginal birth, with or without sutures. Staff are wonderful but by and large units are often understaffed so women who “choose “to breastfeed are not in fact that well supported, actually in a bfi unit, the women don’t choose to breastfeed, as that is the only option open to them and this is so very wrong. If you want to room hey that’s great, if you don’t want to room in too bad for you, is the way this goes. Sure promoting breastfeeding is a good idea, but a policy that forces all women to follow that initiative is never a policy, was never a policy that took into account womens’ needs and rights, or the babies’ needs or rights. The unseemly rush to gain bfi endorsement is sickening. The policy makers have lost the bloody plot.

    • momofone

      There is absolutely no one-size-fits-all solution, and that includes the “rules” about breastfeeding–no pacifiers, rooming in, skin to skin, etc. I’m not talking about official rules, but the typically accepted ones I heard before my son was born. I was warned that pacifiers and bottles of formula or sugar water given by the nurses would surely prevent him from breastfeeding, or he’d develop nipple confusion, or some equally awful thing. I was told that I just needed to hope I didn’t have to have a c-section, because the recovery would be awful, and my milk wouldn’t come in on schedule, and of course that would result in difficulty breastfeeding if it worked at all. I went to the hospital scared to death that I’d probably already screwed it up somehow, before he was even born. I had a (wonderful) c-section and a smooth recovery, though my son and I were found to have had a blood incompatibility that resulted in his being in special care for days before we could do more than touch his head, much less breastfeed. Despite our request that they not give him a pacifier, they did (thank goodness), and he loved it from the first minute. In addition to IV fluids he had to have formula to help clear the jaundice, and though I was pumping, it was almost a week before I got to try to breastfeed him. Just about everything that was sure to sabotage breastfeeding, we figured it out and continued until he was almost two. All this to say that all the magical breastfeeding “support” allowances in the BFHI may not be so magical; allowing a mother to choose whether she wants to room in or not is probably not going to be the end of breastfeeding unless she decides so, nor will any of the other guidelines, and possibly not all of them combined. What helped me was a very supportive and involved partner, who insisted that I rest, which I could not have done if my son had been tossed at me in the recovery room and from then on. In my experience, what did the “major disservice” was the idea that if I didn’t do it all “right” from the first moment on, we were doomed.

      • guest

        Me too – premature twins and I was literally tied to a bed for the first 24 hours after they were born (with those leg massage things to prevent blood clots). I pumped and they were bottle fed what I produced. They were not held much for the first week of their life, they were poked and prodded and had weird things taped to their bodies. They had pacifiers and hats and were not fed on demand (fed every three hours, on the dot). I brought them home, we consulted an LC and went on to breastfeed for seven months. I chose to stop because I was massively overproducing and getting clogged ducts all the time, but we did everything “wrong” in the beginning and were still able to breastfeed.

        • momofone

          Overall, I’m glad I did it, but I can see looking back that I made myself crazy over it. If I had it to do again, I’d relax more–and supplement–so I could spend more time enjoying my baby.

          • guest

            If I were to do it again, I’d quit sooner, that’s for sure. Probably still do it for the first 2-3 months, assuming all went like last time.

    • guest
      • MaineJen

        Your winnings, sir…

        • guest

          I am shocked, shocked, to find that formula feeding is going on in here…

      • KeeperOfTheBooks