Fewer hospitals have been distributing formula samples to families with newborn infants than they used to. I suspect I’m meant to feel happier about that as a pediatrician than I do.
According to a new study by the Centers for Disease Control published in the journal Pediatrics, from 2007 to 2013 the percentage of hospitals offering infant formula discharge packs to new mothers declined by over 40 percent. At the start of the study period, nearly 73 percent of hospitals offered them, which declined to about 32 percent at the end.
This change in hospital policy is in keeping with a broader effort to support breastfeeding as the best means of nourishing a newborn infant. The American Academy of Pediatrics (of which I am a member) recommends exclusive breastfeeding for the first six months of a baby’s life.
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The study’s authors posit that this trend is part of hospitals’ increased participation in the Baby-Friendly Hospital Initiative. By following the “Ten Steps to Successful Breastfeeding,” hospitals designated “Baby-Friendly” comply with the World Health Organization’s International Code of Marketing of Breast-milk Substitutes. In an effort to “protect and promote breastfeeding,” compliance with the Code means distribution of free formula samples is strictly verboten.
Truth be told, I have never been enamored of the chosen designation “Baby-Friendly,” with its clearly exclusionary implications. Anything other than exclusive breastfeeding is, per those terms, baby unfriendly by default. It communicates something smugly judgmental about an immensely personal decision each family must make, in a manner that sets my teeth on edge.
Because this is the Internet and therefore nothing can ever go without saying, I need to pause and make clear that I absolutely support new mothers who choose to breastfeed. I agree that nursing is the optimal way of nourishing a newborn infant, and for those who opt for it, I spend a large amount of time with each family, talking about how breastfeeding is going. My practice recently hired a lactation consultant to better assist these families, precisely because we recognize the importance of offering as much help as we can.
However, the moral freight that is attached to a new mother’s decision whether or not to breastfeed has gotten grossly out of hand. Among nursing’s most ardent advocates, choosing to give your child formula is accorded roughly the same respect as announcing you plan to feed the baby a steady diet of Brandy Alexanders.
As I have written before, the sense of failure I have seen time and again in women who (for whatever reason) struggle with breastfeeding is profound. Many express a feeling that it is tantamount to failing as mothers. Never mind that the claimed benefits of breastfeeding outstrip the science in many areas.
The very existence of such a thing as a lactation consultant indicates that breastfeeding doesn’t always happen easily or well. Much as organizations like La Leche League might tout it as “the normal, healthy way to nourish and nurture your baby,” it can be painful or difficult. In some cases, newborn babies can lose a dangerous amount of weight after discharge from the hospital while they and their mothers are trying to get the hang of the breastfeeding routine.
Furthermore, because of their frustrating obliviousness to parental convenience, sometimes these newborns have particular trouble in the dead of night. If I get a call from a frantic new parent at 2 AM because their infant just can’t seem to latch and it’s been hours since the last time it had a wet diaper, sometimes a short period of supplementing with formula can get families over the hump, stabilize the baby’s weight and hydration, and alleviate a great deal of unnecessary anxiety. It doesn’t strike me as especially horrific to provide these families with a sample to have on hand for such a contingency, rather than hoping they can find an all-night formula retailer nearby so they can feed their baby.
While I certainly agree that supporting those families who choose to breastfeed and encouraging the practice is beneficial, there’s something vaguely coercive about restricting their option to do otherwise. Encouraging hospitals to curtail distribution of formula in service to these goals seems suspiciously like paternalistically limiting the availability of choices we deem undesirable. If a new mother’s commitment to breastfeeding is so tenuous that the ready availability of formula can materially undermine it, doesn’t that imply she might have reasons worthy of consideration to want a handy alternative?
Maybe she finds the constant interruption of her sleep routine more exhausting than she can tolerate. Perhaps she has a medical condition like a seizure disorder that makes sleep deprivation a risk to her own health. It could be that breastfeeding has become such a challenging fixation that it has eclipsed her ability to take care of herself, relax and enjoy being a new mom. Or maybe it’s nobody else’s damn business what her reasons are for parenting her child how she chooses.
Do I think breastfeeding a new baby is best? Yes. But that hardly means the babies who get some or all of their nutrition from formula are less well-loved or suffering some sort of harm. I know I’m supposed to celebrate the trend in hospitals making formula samples unavailable, but I am instead ambivalent. I’m glad to support mothers who choose to nurse, but I’m loath to celebrate policies that tell the others they’re doing something wrong.
