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Should Hospitals Give Free Formula to New Moms?

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If you delivered your baby in a hospital, chances are you went home with infant formula samples in your bag. I know I did. Maybe you even got a little goodie bag from a formula manufacturer, filled not only with free formula, but also with informational pamphlets on new-baby care? I got those, too. I’d made it clear (via a giant sign on Kaspar’s rolling crib that read “Breast ONLY,” and repeated requests to meet with the hospital’s one, part-time on-staff breastfeeding consultant) that I was one of those moms who wanted to breast feed exclusively. The breastfeeding consultant showed up just as I was signing my hospital discharge papers. We didn’t have much time to talk. A few days later, when I expressed my concerns about Kaspar’s latching-or-digestion-or-something (he had reflux) situation to a close, three-time breastfeeding pro of a friend, she suggested I could try feeding Kaspar formula in addition to breast milk. I asked, “Can you do that?” and she reassured me that yes, you can.

I ended up being one of those moms for whom breastfeeding works, but not exclusively. Having formula on backup was a huge relief in this context; Kaspar drank a combination of my milk, another friend’s milk, and organic formula -- not the brand that I got in the hospital bag, although we did use that initially. Cuz hey, it was free. Given that my own milk supply wasn’t what I’d hoped it would be, and that we did have some digestion issues and such, I’m grateful to my friend for removing, for me, my sense that it was either/or when it came to breast or bottle. I did my best balancing nursing, pumping, and formula-feeding, and Kaspar rocked the remix just fine; if he was confused over which nipple belonged to me or to the bottle, it didn’t seem to bother him. He chowed down either way. As much as I appreciated adopting a ‘find what works’ perspective, too (first lesson in parenting: don’t get too attached to plans), I found those initial days in the hospital – as I tried to figure out the mechanics of nursing from a book I’d brought along, and not from a real person -- stressful. I was concerned while recovering there that Kaspar would be given formula either by mistake or against my wishes. My assigned roommate’s twin babies were receiving formula, as were most of the babies in the nursery; it was clearly standard procedure. I didn’t receive any informational pamphlets on breastfeeding, that’s for sure. I really had to ask for breastfeeding support. Which I did, because I’d already decided I wanted to breastfeed. But if I’d been on the fence, or hadn’t thought about it at all, it would have been bottles from the get-go, by default.

As increasing evidence suggests that new moms feel more inclined to breastfeed when information on the how and why of doing so is provided for them (rather than ‘available upon request’), and as the AAP has released new recommendations that babies be exclusively breastfed for at least six months, dozens of consumer and health organizations have now appealed to hospitals to stop doling out the free formula -- and pamphlets, coupons, etc. -- to moms who’ve just given birth. While breastfeeding doesn’t work for everyone, the history of human survival would suggest that it can certainly work for more than 14 percent of infants – the current rate of American infants going steady on the ‘liquid gold.’ US health officials hope to almost double that rate by 2020, too; there’s no question at this point that breast milk really is best for babies, health-wise. That formula (and “information” about its health benefits) is automatically provided to new moms in hospitals, when information and instruction on breastfeeding is often hard to come by and yet crucial to breastfeeding success, seems… um (trying to put this nicely)… like hospitals are missing a huge opportunity to be a part of boosting those breastfeeding rates.

In his letter to hospital chief executives, Public Citizen President Robert Weissman wrote that hospitals aim "to promote the health of infants and mothers, but the ongoing promotion of infant formula conflicts with this mission.” This is right on. Hospitals are indeed promoting, rather than simply providing, infant formula by handing out branded literature on formula, with product. Whether they’re discouraging women from breastfeeding by doing so, as the letter-writers suggest, is debatable, but I’d put good money on a bet saying better breastfeeding information and support in hospitals would increase breastfeeding rates like a charm. In fact, The AAP’s updated recommendations on breastfeeding specifically identify hospitals and pediatricians as major players in supporting breastfeeding success.

Hospitals contend that women want the formula samples, and that "having information and resources available for mothers who choose not to breastfeed is a responsible and supportive approach for the hospital,” according to a statement from the American Hospital Association. Well, duh. The thing is, more women will also want to breastfeed if information and support (not pressure, just so we’re all clear) around that is provided to them in the hospital, too. Of course hospitals should have formula on hand for moms who can’t, or choose not to, breastfeed. But let’s keep it real here. Unless things have changed dramatically since I gave birth in 2010, hospitals aren’t assuming women will breastfeed and then making formula and information on formula ‘available’ if that doesn’t work out for them. Hospitals are handing out corporate formula makers’ swag bags to everyone who leaves the premises with a new baby in their arms.

KJ Dell’Antonia wrote last week in her blog Motherlode about the hidden costs of breastfeeding, shedding light, perhaps, on one of the reasons lower-income moms breastfeed at lower-than-average rates: breast milk is not, due to the challenges of pumping or nursing amidst inflexible employment situations, free. She wrote, “if the American Academy of Pediatrics’ recommendation that mothers breast-feed for 12 months or more (and breast-feed exclusively for six months or more) is meant for all women, not just those with the resources to withstand economic loss — then we need to support breast-feeding by putting in place laws, policies, programs and social structures that make it easier, rather than attempt to gloss over its hidden costs.” Free formula will obviously appeal to moms for whom economic concerns are pressing, and for whom convenience will be a major factor in feeding their kids. But handing out formula as the ‘solution’ to their problems (or just because they ‘want’ it) fails to address the root of those problems (or the best interest of their babies)—that our society is not supportive of breastfeeding moms. Hospitals, at the very least, should be.

What do you think? Should hospitals stop handing out corporate formula swag? Did you receive any breastfeeding support after delivering in a hospital setting? How do you think the hospital systems could be improved to meet the needs of all moms? (Including moms like me, for whom exclusive breastfeeding was not straight-forward and entirely ‘successful’)?

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