The lactivist attack on the Fed Is Best Foundation is a perfect example of shooting the messenger.
According to Wikipedia:
“Shooting the messenger” is a metaphoric phrase used to describe the act of blaming the bearer of bad news.
In this case, the bad news is that the relentless efforts to promote breastfeeding are leading to babies being injured or killed by accidental starvation.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]What’s the difference between formula companies letting babies die from contaminated water to increase market share and lactivists letting babies die from insufficient breastmilk to increase market share?[/pullquote]
From the lactivist point of view, the bad news brought by the Fed Is Best Foundation has three components:
- Breastfeeding is not perfect.
- Infant starvation is common.
- The Baby Friendly Hospital Initiative (BFHI) hurts and even kills babies.
The Fed Is Best Foundation functions as an industry whistle blower and as in any industry, lactation industry leaders are desperate to suppress and discredit anyone who threatens maketshare. It is a sad irony that the lactation industry has become exactly what it despised about the formula industry. As its attacks on the Fed Is Best Foundation make clear, market share is more important than babies’ lives.
And even greater irony is that they use exactly the same tactics as Nestle, the avatar of the contemptible formula industry used:
- Exaggerating benefits
- Ignoring Risks
- Claiming the imprimatur of “science”
Nestle also tried to shoot the messenger and the result should give pause to the critics of the Fed Is Best Foundation. Nestle brought libel charges in Germany:
Nestlé had a fast response to this event and decided to sue the publisher of a German-language translation of War on Want. The multinational corporation did not want to accept the allegations. After a two-year trial, in 1976 the court found in favor of Nestlé because they could not be held responsible for the infant deaths in terms of criminal law. The defendants were only fined 300 Swiss Francs (if adjusted to inflation, over US$400). The judge found the 30 members of TWAG guilty of libel.
It won the libel battle, but it lost the public relations war.
The first Nestlé boycott in 1977 has been led by Infant Formula Action Coalition (INFACT) and had a large negative impact on Nestlé’s revenues… The boycott campaigners set a goal to improve total infant nutrition and health of babies throughout the Third World countries as well as to resolve this issue on a global basis.
The boycott against Nestlé’s products and the infant formula manufacturers generated the largest support of the consumer movement in North America, and its impact has still been felt in the industry around the world. The Nestlé boycott has been lasting for 7 years in 65 countries and ended in 1984 after the world’s leading organizations took a variety of restrictive actions against Nestlé. The company lost more than $5.8 million in revenues.
By relentlessly attempting to discredit the Fed Is Best Foundation, the lactation industry seems determined to repeat Nestle’s mistake: win the battle yet losing the public relations war. That’s despite the fact that the lactation industry has an advantage that Nestle did not have.
Nestle could not afford to acknowledge the risks of their product. The water in third world countries was often contaminated, and the poverty of the purchasers led to them to dilute the product thereby harming their babies. Informing women of these risks would have dramatically reduced the number of women purchasing formula.
In contrast, acknowledging the risks of breastfeeding would not mean a drop in market share for the lactation industry. Women could still breastfeed and supplement with formula when necessary. But breastfeeding is more than just a business decision for the lactation industry; it is a lifestyle decision. Acknowledging that other mothers may have valid reasons for using formula might diminish lactivists’ sense of superiority regarding their own ability to exclusive breastfeed. That is apparently an intolerable sacrifice.
But the lactation industry, like Nestle before it, is fighting against the truth and will inevitably lose:
Breastfeeding has real risks and refusing to acknowledge them discredits lactivists, lactation consultants and the breastfeeding organizations like La Leche League and the BFHI.
Shooting the messenger, in this case the Fed Is Best Foundation, calls the credibility of the lactation industry into question. Attempting to silence an industry whistle blower often precipitates a public relations debacle.
Most importantly, heartless behavior — letting infants scream in hunger, suffer injuries from dehydration and low blood sugar, and even die — is profoundly immoral. That’s what Nestle did and they paid the price. Surely the lactation industry can learn the lesson that letting babies die in order to preserve market share is not merely deeply unethical, but unprofitable, too.
Individualized Care in the Baby-Friendly Hospital Initiative
A recent Fed is Best (FIB) Foundation blog tells the tragic story of Landon, an infant who died at 19 days of age. Baby-Friendly USA extends its deepest sympathy to his family.
The lesson of this story is not that exclusive breastfeeding is dangerous as the FIB Foundation suggests. Most infants exclusively breastfeed successfully with no major health problems. Breastfeeding is safe and is the method of infant nutrition recommended by national and international health authorities such as the Centers for Disease Control (CDC), the American Academy of Pediatrics (AAP), and the World Health Organization (WHO).
The real lesson of this story is that there are certain conditions that require further assessment and close follow up with the mother, infant, or both. This kind of care is called for in the Baby-Friendly Guidelines and Evaluation Criteria (https://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria) which clearly state that “additional individualized assistance should be provided to high risk and special needs mothers and infants and to mothers who have breastfeeding problems”1. The news reports about Landon point to some critical factors that put him at high risk, such as a complicated delivery with evidence of inadequate oxygenation at birth. The autopsy lists hypoxic-ischemic encephalopathy, which may have contributed to this child’s death.
High risk conditions do warrant increased monitoring along with the creation of specific infant feeding and care plans, which may or may not include supplementation with infant formula. The Guidelines and Evaluation Criteria do allow for supplementation for medical reasons and when mothers have made an informed, educated decision2.
The decision to supplement is a delicate one. Infant formula changes the infant’s gut. It can also negatively impact the establishment of the mother’s milk supply, thus effecting long term breastfeeding success. Practitioners must carefully weigh the risks and benefits of this decision.
While Baby-Friendly USA cannot comment on individual cases, we would like to point out how the Baby-Friendly Guidelines and Evaluation Criteria indicate ways to provide lactation support to mother infant pairs with feeding difficulties:
“Health care professionals should assess the mother’s breastfeeding techniques and, if needed, should demonstrate appropriate breastfeeding positioning and attachment with the mother and infant, optimally within 3 hours and no later than 6 hours after birth. Prior to discharge, breastfeeding mothers should be educated on basic breastfeeding practices, including:
1 http://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria, Guideline 5.1 p. 16 accessed 3/13/17
2 http://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria, Guideline 6.1 p. 18 accessed 3/13/17
1) the importance of exclusive breastfeeding,
2) how to maintain lactation for exclusive breastfeeding for about 6 months,
3) criteria to assess if the infant is getting enough breast milk,
4) how to express, handle, and store breast milk, including manual expression, and
5) how to sustain lactation if the mother is separated from her infant or will not be exclusively breastfeeding after discharge.”3
Mothers expressing discomfort with breastfeeding or who are exhibiting irritated, cracked or bleeding nipples especially require this assessment.
“Additional individualized assistance should be provided to high risk and special needs mothers and infants and to mothers who have breastfeeding problems or must be separated from their infants.”4
Mother’s with metabolic disorders and physiologic conditions that might alter their ability to produce an adequate supply of milk should have their milk production and milk transfer assessed periodically during the hospital stay and again, before discharge. Individualized plans of care should be implemented accordingly.
“The designated health care professional(s) should ensure that, prior to discharge, a responsible staff member explores with each mother and a family member or support person (when available) the plans for infant feeding after discharge…an early post-discharge follow-up appointment with their pediatrician, family practitioner, or other pediatric care provider should also be scheduled. The facility should establish in-house breastfeeding support services if no adequate source of support is available for referral (e.g. support group, lactation clinic, home health services, help line, etc.).”5
The care described in the news reports and blog regarding baby Landon are not consistent with the full implementation of the Baby-Friendly Hospital Initiative Guidelines and Evaluation Criteria. Baby-Friendly USA certifies hospitals based on a large set of criteria that must be maintained by the hospital itself. Being Baby-Friendly does not and cannot assure that every staff member will perform according to Baby-Friendly standards. However, in 2012, Baby-Friendly USA implemented a quality improvement program that requires hospitals to annually audit and report on their practices. Quality improvement plans are required for facilities whose audit results indicate their practices have fallen below the Baby-Friendly standards. Baby-Friendly USA continues to strengthen this program.
Links to some additional comments on the topic.
Hypernatremia Dehydration
Why Fed Will Never Be Best: The FIB Letting Our New Mothers Down
3 http://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria, Guideline 5.2 p. 17 accessed 3/13/17
4 http://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria, Guideline 5.1 p. 16 accessed 3/13/17
5 http://www.babyfriendlyusa.org/get-started/the-guidelines-evaluation-criteria, Guideline 10.1 p. 22 accessed 3/13/17
Resources for Families and Healthcare Professionals
Office on Women’s Health-Breastfeeding
Office on Women’s Health-Breastfeeding Fact Sheet
Office on Women’s Health-Your Guide to Breastfeeding
CDC-Breastfeeding
AAP Breastfeeding Residency Curriculum
AAP Breastfeeding Initiatives
AAP Sample Breastfeeding Assessment Questions
AAP Prepare for Breastfeeding Success
The Surgeon General’s Call to Support Breastfeeding and Breastfeeding Fact Sheet
ACOG Breastfeeding Toolkit
ACOG Breastfeeding Frequently Asked Questions
American College of Nurse Midwives – What to Expect in the Early Days of Breastfeeding American Academy of Family Physicians – Strategies for Breastfeeding Success
Supplementation Guidelines
AAP Policy Statement: Breastfeeding and the Use of Human Milk
ABM Clinical Protocol #3
I’m very supportive of breastfeeding when that’s what mum wants to do. Having breastfed three kids and having been a peer educator and now being involved in maternal care, I know my way around a nipple.
One of the biggest lies when it comes to lactivists is the obsessive focus on absolute, 100% exclusive breastfeeding. The fact that women are told how even one bottle will ruin their breastfeeding relationship – to the point I have seen people sobbing uncontrollably as they give their starving infant a much-needed bottle, or crying out with pain as an infant latches onto macerated nipples – is one of the cruelest parts of this whole mess. Mum suffers and baby starves because mum’s terrified of even having formula in the house because she might ‘give in.’
First, feed the baby. Worry about supply later. In someone without breast structural or endocrine issues, it is possible to correct the impact on supply of early supplementation (if there is any impact at all. I’ve seen plenty of pairs where baby, once fed and full of energy, had a much easier time learning how to breastfeed.) For someone with supply issues, they need to supplement anyway so encouraging it from the outset means baby spends less time hungry. Still can’t figure out why that’s considered a bad thing by these people.
It’s the virgin gut and/or worries about impacting mom’s supply.
I remember having nurses in the hospital freaking out about my supply because my daughter (full term, average weight, no complications) didn’t seem hungry and didn’t want to nurse much and just slept. Since then I’ve pieced together that since she was slightly jaundiced (not enough to need bili lights) she was probably sleepier than the average newborn, and needed to eat more to get the jaundice cleared, and a bottle of formula would have gotten her going. Whatever. She’s fine now. But I wish they’d either insisted that we give her a bottle to clear the jaundice, or just left us alone and quit hassling us to try to make her wake up and eat, which she refused to do. Of course my milk came in with a vengeance a few days later and I had to deal with oversupply, which I hadn’t even ever been told was a thing. The whole hospital process was just not helpful in that respect.
Imagine if moms just shrugged and supplemented if BF didn’t work out instead of following every suggestion of their LC while paying a lot for their services and wares. That’d be only good for mums, babies and breastfeeding as a feeding choice, but not the bottom line of the current BF industry. Can’t have that.
Indeed. Imagine if we collectively supported all parents making reasonable choices regarding their children, without making it into a competition or passing noisy judgement.
Semi-OT: I think I’m going to have to avoid the new parachuting lactivist. Unfortunately, I responded to her before I realized she’ll likely set off the bad thoughts.
I’m in a bad mood so I went ahead and waded in. Bonus — I popped my getting told to “do your own research” cherry so I feel like one of the cool kids now.
You take care of yourself though and avoid if you need to.
She’s now suggesting you bake your newborn baby in the sun so they can get adequate vitamin D levels. Because she is such a turd, she won’t admit breast milk isn’t a perfect food. I guess all those digested stem cells will jump over magically to the melanoma, become undigested and cure it! She is our new Nikki Lee.
I saw that. When I’m teaching and training I spend all day, every day outside and granted this is overcast Oregon (except for our three months of glorious sun) and I’m STILL deficient.
That wouldn’t work in my neck of the woods, either. Western Michigan has nearly continuous cloud cover from October through March thanks to Lake Michigan.
My son was born in mid December so there wasn’t a whole lotta sunlight to be had. But in the summer here it’s easy to get burnt in 10 to 15 minutes.
I could have done it(baked my kid outside to get Vitamin D), except I lived in L.A. for the first 2 months of her life and then Guam for the next 2 years and I’m not an idiot. Yeah put my blonde, blue eyed, whiter than marshmallow fluff infant out in the tropical Sun for an extended period of time. As my father had multiple bouts of skin cancer, that would be a hard pass…
My 16 month old, who is also super fair skinned, blond and blue eyed, was slathered in sunscreen to hunt eggs yesterday. I chose to put a vitamin D drop instead in his morning milk. I’d rather just admit nature is no where near perfect and embrace science.
I gave birth in February in the north of England. The sun hadn’t been out for a while.
Yeah, I’m less than 1/2 a mile from Lake Erie, and my boyo was born in November
The sun is natural, therefore good! Let’s see if she has Nikki Lee’s staying power.
She has already done her first flounce, unless she’s back in another thread?
I haven’t seen her…….But Nikky lee is back
Where? Disqus works kind of wonky on my phone.
http://www.skepticalob.com/2015/06/babies-are-dying-because-breastfeeding-advocates-are-lying.html
Thanks. 🙂
There is a lot of money on the line. Firstly, anyone who’s in charge of selling the Baby Friendly moniker to hospitals. Secondly, anyone whose business it is to cater to the exclusive breastfeeders will lose money if women are just like, “Oh well, I’ll just supplement with a bottle.”
I agree. There are two models that work well to describe lactivism – sacrificial cult and crooked business.
Really, it reminds me of the problems with Scientology. Lactivism acts like a Gnostic religion – “Come to me and I will teach you the secrets required to EBF successfully” – with a cash-for-service model.
Anyone remember the Ezzos’ Baby Wise program, where you feed newborns on a schedule? (Someone gave me the religious version of the book.) It was awful, leading to failure to thrive and attachment problems. And yet, attachment parenting, especially Boobies Uber Alles, though superficially the polar opposite of “parent-directed feeding” (accompanied by letting newborns cry it out for hours, if necessary), seems to me to contain the same blindness to dangers that mark the Ezzo program. “If you don’t follow our One True Path, you are dooming your child!” is the same, unsubtle subtext in both cases.
Very similar ideas to that essay Dr. Amy wrote about last week, the idea of growing a “super baby”. Doing everything perfectly to assure a superior offspring. It isn’t that simple.
I think this is my favorite SOB post ever! Thanks for the good work you do Dr. Amy