The New Latch On NYC Program

[Cynthia Mosher]

This story caught my eye because I'm working with a team of students and doctors to get the Baby Friendly Hospital Initiative going in hospitals in our city. But this is a bit stronger and I'm wondering how women will receive it.

The program Mayor Bloomberg is launching in NYC requires new moms to sign for formula to receive it for their babies. Before they are given the formula they listen to a "mandated talk" from a staff member or nurse about why breatsfeeding is better. Here's the story.

Is the mandated talk a bit much? Or is it really necessary to raise awareness? I can imagine someone who has already made the decision to formula feed, for whatever reason, will not be happy having to sit through a mandated talk. 

For those posting to share their views, please know that we may post this story and link to this thread on Mothering's FB page. 

[QueenOfTheMeadow]

I honestly don't think a mandated talk is too much.  I was required to go to a talk about how to care for a newborn before I left the hospital with my first child, and I'm pretty sure that if your child is circumsized you have to listen to a talk on the care of their penis.  So, since choosing to formula feed over breastfeeding raises the risks of various immediate health issues and longterm health issues for babies and mothers, it seems like having to be educated on those risks makes sense.

I don't particularly like the way this story was presented though. 

 a new program urging hospitals to keep baby formula under lockdown.

Lockdown?  Seriously?  They are sending the formula to jail?  They also make it sounds like mother's aren't being given the choice to formula feed, when in reality, they are given the mothers an opportunity to make an educated decision.  Isn't that what we want our health care providers to do? 

  I would love to see the language surrounding breastfeeding changed as well.  It's not the benefits of breastfeeding that should be addressed.  It's the risks of forumula feeding.  I think that would go a long way towards changing the outlook on breastfeeding in the US. 

[JudiAU]

Helping women make an educated decision seems like a worthwhile goal.

[MeepyCat]

I think the mayor is overstepping, and that this initiative will ultimately result in ALL mothers in NYC hospitals receiving lower-quality care from nurses, who now have to go through this time-consuming song and dance before they can hand over the formula.  The nurses (who now have to traipse off in pairs to get formula out of a special cabinet every time anyone asks for it, and give a lecture about it) will have less time to spend actually caring for patients.

Furthermore, I don't think that this initiative is likely to increase rates of breast feeding.  I think women use formula because it's convenient, and allows more people to help care for the baby.  They need that convenience because most women need to have jobs to help support their families.  Unless we change some fundamental economic structures, the informative lecture in this circumstance is just a means of making hungry babies wait while we make their mamas feel insulted.

[erigeron]

I fail to see the point of this. Why not just give formula to ppl who ask for it, and otherwise avoid it? Hospitals have protocols for everything--which patients get what care when is mapped out in many predetermined ways. I don't see why it's so hard to have two protocols for post-partum; one for breastfeeders (and it would include circumstances under which to discuss supplementing) and one for formula feeders (give them formula and then quit bugging them about it). It's only an issue because they're trying to have a one-size-fits-all solution and they really need two different ones.

I don't see any point to the education sessions. I think that most people know that breast is best. It's not like the care of the circumcised penis where there are (I assume) specific things to be done and not done and most people will not have encountered it if they haven't done it themselves.

Really, a lot of pro-breastfeeding initiatives seems pretty ridiculous to me, because they don't seem to address moms' actual needs, and then the speculation about why they don't work never seems to involve asking moms why they stopped breastfeeding. If policymakers want to know what will help more moms breastfeed, they should ASK MOMS.

[QueenOfTheMeadow]

Originally Posted by MeepyCat 

I think the mayor is overstepping, and that this initiative will ultimately result in ALL mothers in NYC hospitals receiving lower-quality care from nurses, who now have to go through this time-consuming song and dance before they can hand over the formula.  The nurses (who now have to traipse off in pairs to get formula out of a special cabinet every time anyone asks for it, and give a lecture about it) will have less time to spend actually caring for patients.

Furthermore, I don't think that this initiative is likely to increase rates of breast feeding.  I think women use formula because it's convenient, and allows more people to help care for the baby.  They need that convenience because most women need to have jobs to help support their families.  Unless we change some fundamental economic structures, the informative lecture in this circumstance is just a means of making hungry babies wait while we make their mamas feel insulted.

Apparently it has increased the rates of breastfeeding already. 

“New York City is definitely ahead of the curve,” said Eileen DiFrisco, of NYU Langone Medical Center, where the breast-feeding rate has surged from 39 to 68 percent under the program.

 http://www.nypost.com/p/news/local/mayor_knows_breast_WqU1iYRQvwbEkDuvn0vb1H#ixzz22OjF0Ksc

 I agree many women have to return to work, and there are many mothers who are not given the places or the time to pump and keep milk.  But, even 2 weeks of breastfeeding for a baby can have lasting effects on the babies health.  And maybe if women were more educated with the fact that their chldren are at higher risk for many diseases without breastfeeding, those options will become more open. 

As far as getting less quality of care from nurses, I would think that giving mothers information that allows them to make educated choices would be giving them better care, not less. But, maybe in order to save time, they could add the talk to the new baby class that most parents are required to take before leaving with their baby.

There are a lot of changes that need to take place to support the breastfeeding relationship between mothers and babies.  I think this is a good step in the right direction.  Honestly, I think that this move will lead to more options for mothers to breastfeed or pump at work.  Wouldn't it be great if mothers wouldn't have to choose between giving their babies the best possible start in life and continuing with their careers?

[QueenOfTheMeadow]

Originally Posted by erigeron 

I don't see any point to the education sessions. I think that most people know that breast is best. It's not like the care of the circumcised penis where there are (I assume) specific things to be done and not done and most people will not have encountered it if they haven't done it themselves.

I totally disagree with this statement.  The lack of education and understanding breastfeeding is outstanding.  The negativity surrounding breastfeeding is enough to keep even women who want to breastfeed fail, because they don't have the support there to try and work through the difficulties.  If there was a true understanding of the increase possibility of serious short term and long term health issues associated with formula feeding, I think a lot more moms would be breastfeeding. 

[MeepyCat]

Originally Posted by QueenOfTheMeadow 

Apparently it has increased the rates of breastfeeding already. 

 http://www.nypost.com/p/news/local/mayor_knows_breast_WqU1iYRQvwbEkDuvn0vb1H#ixzz22OjF0Ksc

 I agree many women have to return to work, and there are many mothers who are not given the places or the time to pump and keep milk.  But, even 2 weeks of breastfeeding for a baby can have lasting effects on the babies health.  And maybe if women were more educated with the fact that their chldren are at higher risk for many diseases without breastfeeding, those options will become more open. 

As far as getting less quality of care from nurses, I would think that giving mothers information that allows them to make educated choices would be giving them better care, not less. But, maybe in order to save time, they could add the talk to the new baby class that most parents are required to take before leaving with their baby.

There are a lot of changes that need to take place to support the breastfeeding relationship between mothers and babies.  I think this is a good step in the right direction.  Honestly, I think that this move will lead to more options for mothers to breastfeed or pump at work.  Wouldn't it be great if mothers wouldn't have to choose between giving their babies the best possible start in life and continuing with their careers?

I see the stat you're quoting, Queen of the Meadow, but I wonder whether the increase in breastfeeding rates at one hospital might be more of a marketing effect - the hospital has, and publicizes, a "breast feeding friendly" policy, women who already know they feel strongly about breast feeding see it as a benefit and chose that hospital, while women who know they're likely to need formula go elsewhere.  The program doesn't start citywide for another month, and we won't be able to evaluate its citywide effect for quite some time.

My concern about quality of nursing care isn't that it's not good to give patients information, it's that I haven't yet seen a hospital with too much nursing staff.  Giving nurses a deliberatly time-consuming set of extra work is bad, IMO, because nurses already have a ton of genuinely time-consuming, vitally necessary work to do.  There are only so many hours per shift, and only so much staff.  The number of hours of nursing care available to patients is finite, and the number of hours that can be absorbed by patient needs is infinite.  I've spent a big chunk of my time in the hospital lately, and I've sometimes had to wait an hour and a half for tylenol, because I happened to start hurting just at the beginning of rounds.  Imagine waiting that long to feed your hungry baby.  Maybe longer, because your nurse has to round up a second nurse to go get it.  (Would you, in that time, just give up and nurse the baby?  Maybe.  Or maybe you're already bleeding from a milk blister, or maybe you're a sobbing hormonal wreck.  Or maybe you've just sent your partner to buy you some at the grocery store, that you will mix up with warm-ish water from the tap in the bathroom, and feed the babe out of a bottle and nipple you didn't get a chance to wash first.)

Also keep in mind - this policy as written isn't just going to apply to healthy women who we can smugly presume don't know better, it also applies to SA survivors who find nipple stimulation traumatic, and to breast cancer survivors who don't even have mammary glands anymore.  I sincerely hope that it's not expected to apply to the NICU, where they're pretty free with formula, for really good reasons.

I think it is naive to expect that this program will have any effect outside the hospitals it's implemented in.  Employers are already supposed to be legally required to provide space and pumping breaks for employees, and bunches of them are in various kinds of violation of that law.  This program involves NO incentives for employers.  NOTHING.  So why should they spend money (which they'd have to do) to comply with a legal requirement that it's clear they can safely ignore?  What about this program makes it worthwhile for them to do that?

I do think it would be great if women didn't have to choose between giving their babies the best possible start and continuing their careers.  Design me a program I think has half a chance of helping that happen, and I will leap gleefully on board.  I'll bring me, and friends, and money, and we can get that program going all over.  This?  Does not look to me like that program.

I even worry about how you've phrased it - "Continuing their careers." Every time we shift a conversation about women and children from "jobs" to "careers" we insert the implication that women's work isn't really vital.  Surely they could back burner their ambitions for just a few years.  For a lot of women, getting back to work is about keeping the rent paid.  For a lot of women, nursing or not isn't about balancing the baby's needs with their ambitions, it's about ensuring that they don't lose the job that keeps them from being homeless.  It's about making sure that they limit the risk that they'll lose their health insurance.  I think we need to confront that need in these conversations, and recognize that women's work is necessary to many families, and can't be traded in for incremental advantages.

Edited by MeepyCat - 8/2/12 at 8:20am

[QueenOfTheMeadow]

Originally Posted by MeepyCat 

I see the stat you're quoting, Queen of the Meadow, but I wonder whether the increase in breastfeeding rates at one hospital might be more of a marketing effect - the hospital has, and publicizes, a "breast feeding friendly" policy, women who already know they feel strongly about breast feeding see it as a benefit and chose that hospital, while women who know they're likely to need formula go elsewhere.  The program doesn't start citywide for another month, and we won't be able to evaluate its citywide effect for quite some time.

My concern about quality of nursing care isn't that it's not good to give patients information, it's that I haven't yet seen a hospital with too much nursing staff.  Giving nurses a deliberatly time-consuming set of extra work is bad, IMO, because nurses already have a ton of genuinely time-consuming, vitally necessary work to do.  There are only so many hours per shift, and only so much staff.  The number of hours of nursing care available to patients is finite, and the number of hours that can be absorbed by patient needs is infinite.  I've spent a big chunk of my time in the hospital lately, and I've sometimes had to wait an hour and a half for tylenol, because I happened to start hurting just at the beginning of rounds.  Imagine waiting that long to feed your hungry baby.  Maybe longer, because your nurse has to round up a second nurse to go get it.  (Would you, in that time, just give up and nurse the baby?  Maybe.  Or maybe you're already bleeding from a milk blister, or maybe you're a sobbing hormonal wreck.  Or maybe you've just sent your partner to buy you some at the grocery store, that you will mix up with warm-ish water from the tap in the bathroom, and feed the babe out of a bottle and nipple you didn't get a chance to wash first.)

Also keep in mind - this policy as written isn't just going to apply to healthy women who we can smugly presume don't know better, it also applies to SA survivors who find nipple stimulation traumatic, and to breast cancer survivors who don't even have mammary glands anymore.  I sincerely hope that it's not expected to apply to the NICU, where they're pretty free with formula, for really good reasons.

I think it is naive to expect that this program will have any effect outside the hospitals it's implemented in.  Employers are already supposed to be legally required to provide space and pumping breaks for employees, and bunches of them are in various kinds of violation of that law.  This program involves NO incentives for employers.  NOTHING.  So why should they spend money (which they'd have to do) to comply with a legal requirement that it's clear they can safely ignore?  What about this program makes it worthwhile for them to do that?

I do think it would be great if women didn't have to choose between giving their babies the best possible start and continuing their careers.  Design me a program I think has half a chance of helping that happen, and I will leap gleefully on board.  I'll bring me, and friends, and money, and we can get that program going all over.  This?  Does not look to me like that program.

I even worry about how you've phrased it - "Continuing their careers." Every time we shift a conversation about women and children from "jobs" to "careers" we insert the implication that women's work isn't really vital.  Surely they could back burner their ambitions for just a few years.  For a lot of women, getting back to work is about keeping the rent paid.  For a lot of women, nursing or not isn't about balancing the baby's needs with their ambitions, it's about ensuring that they don't lose the job that keeps them from being homeless.  It's about making sure that they limit the risk that they'll lose their health insurance.  I think we need to confront that need in these conversations, and recognize that women's work is necessary to many families, and can't be traded in for incremental advantages.

I can see what you're saying.  Especially about women who aren't healthy enough or unable to breastfeed.  I watched my sister try so hard to breastfeed with PCOS and I saw the sadness she experienced when it just wasn't possible.  I certainly wouldn't want her to feel worse than she already did.  It's certainly needs tweeking, and I wonder if we aren't hearing the whole plan. 

  As far as having to provide places to nurse and pump, I'm not sure that's true in every state, and I know some places consider the bathroom a place to pump.  Lovely.  I should have said jobs and careers.  You are certainly right.  I waitressed when my first was a baby, and I'll tell you I had to fight hammer tooth and nail not to have to work double shifts and to have the time I needed to breastfeed.  I was not given a place to pump, and dh actually brough ds to me at work so I could breastfeed, and I got dirty looks at that.  It sucked big time, but we needed the money, desperately. 

[mama24-7]

Originally Posted by QueenOfTheMeadow 

I honestly don't think a mandated talk is too much.  I was required to go to a talk about how to care for a newborn before I left the hospital with my first child, and I'm pretty sure that if your child is circumsized you have to listen to a talk on the care of their penis.  So, since choosing to formula feed over breastfeeding raises the risks of various immediate health issues and longterm health issues for babies and mothers, it seems like having to be educated on those risks makes sense.

Originally Posted by QueenOfTheMeadow 

 I agree many women have to return to work, and there are many mothers who are not given the places or the time to pump and keep milk.  But, even 2 weeks of breastfeeding for a baby can have lasting effects on the babies health.  And maybe if women were more educated with the fact that their chldren are at higher risk for many diseases without breastfeeding, those options will become more open. 

Not everyone believes that artificial milk carries more or significantly more risks though.  So they see this as just another way of being bullied into breastfeeding.  

I read a blog by a woman who FF's (I think she may have tried to BF her first, but I think she FF'd her second from the start).  Add in all those who comment & it's a group of people who say it doesn't matter how you feed your baby as long as you feed them something considered appropriate & you love them.  This couldn't be farther from the truth, but no amount of education/studies/reasoning is going to get to these women (& unfortunately, their babies).  

Sus

[erigeron]

Originally Posted by mama24-7 

Not everyone believes that artificial milk carries more or significantly more risks though.  So they see this as just another way of being bullied into breastfeeding.  

True.

I read a blog by a woman who FF's (I think she may have tried to BF her first, but I think she FF'd her second from the start).  Add in all those who comment & it's a group of people who say it doesn't matter how you feed your baby as long as you feed them something considered appropriate & you love them.  This couldn't be farther from the truth, but no amount of education/studies/reasoning is going to get to these women (& unfortunately, their babies).  

This is a really judgmental comment and could be very hurtful to people who aren't able to BF, or who've decided for whatever personal reasons that BFing is not right for them. THIS is far from the truth. On a population level breastfeeding shows some health benefits, but this doesn't mean that an individual baby fed formula won't be just fine, and most of them are. As for the blog you mentioned, I'd say all parents deserve a chance for support rather than judgment, and that's a site for formula-feeding parents to get support. Because formula is actually a valid infant feeding choice.

[MeepyCat]

Originally Posted by mama24-7 

Not everyone believes that artificial milk carries more or significantly more risks though.  So they see this as just another way of being bullied into breastfeeding.  

I read a blog by a woman who FF's (I think she may have tried to BF her first, but I think she FF'd her second from the start).  Add in all those who comment & it's a group of people who say it doesn't matter how you feed your baby as long as you feed them something considered appropriate & you love them.  This couldn't be farther from the truth, but no amount of education/studies/reasoning is going to get to these women (& unfortunately, their babies).  

Sus

Sus, I made pretty huge efforts to breast feed both my kids. DS was exclusively breast fed for seven months, even though he was in daycare and I was in business school. I didn't completely wean until he was nearly two. DD was in the NICU for 32 days, and I pumped for her from day one. She was fed breastmilk and formula-fortified breastmilk until seven months, when I started having crying jags at the pump. The best thing for my mental health at that point was to stop pumping, but DD continued night and weekend nursing for another six months before weaning herself.

Despite this background, I believe that breastmilk is only a tiny bit best. Most of the advantages disappear if you correct for household income - it's like researchers discover over and over that more money = better pediatric outcomes, and proponents of breastfeeding read it and come out cheering for breast milk.

When I am asked for advice on infant nutrition, I say feed the baby an appropriate food. Don't break your heart or your health over breastmilk vs. Formula. love the baby, and make feeding choices that respect your needs and abilities without apologizing for them.

[mama24-7]

Originally Posted by erigeron 
This is a really judgmental comment and could be very hurtful to people who aren't able to BF, or who've decided for whatever personal reasons that BFing is not right for them. THIS is far from the truth. On a population level breastfeeding shows some health benefits, but this doesn't mean that an individual baby fed formula won't be just fine, and most of them are. As for the blog you mentioned, I'd say all parents deserve a chance for support rather than judgment, and that's a site for formula-feeding parents to get support. Because formula is actually a valid infant feeding choice.

I'm not sure exactly what you believe I've said that is judgemental, but you are free to think that about me. 

 

The fact is is that human milk is what human bodies expect & will grow normally on.  Because of this fact, I've judged the normal feeding method to be normal & a practice I wish to engage in. Therefore, I've judged the alternatives to be undesirable & have not engaged in the practice (although my oldest did receive artificial milk supplementation on the bad advice of her doctor at the time).  I try to craft my words carefully but can not be held responsible for someone making the choice to read something I've written & take it personally. I've written nothing personal here. 

 

Where was I talking about individual babies? Individual mothers?  "Just fine," may be acceptable to every other human on the planet, but it is not good enough for me. I was ff'd from day one & I'm sure I looked fine. I was not & am not today in large part because of it. My children are not fine today because I was FF'd from day one. 

 

I think that FF'ing is a valid choice when there are no other choices. That is not the way society views it however because we (I'm including myself among all others in this society) neither value bf'ing nor breastmilk. 

 

I have no problem with anyone getting support from others in similar circumstances to themselves. What I do have a problem with is people claiming that it does not matter what you/anyone (general you) feed a baby. If that were true then it wouldn't matter when artificial milk is watered down, it wouldn't matter if someone fed their baby juice, or regular cow milk, or anything else. It does not stand up to the test of logic & reason. 

 

As I said, you are welcome to deem me judgmental if you'd like to. I judge actions/ideas/concepts. I have not judged a single person in this post which I would need to do to be judgemental of people.

Originally Posted by MeepyCat 


Sus, I made pretty huge efforts to breast feed both my kids. DS was exclusively breast fed for seven months, even though he was in daycare and I was in business school. I didn't completely wean until he was nearly two. DD was in the NICU for 32 days, and I pumped for her from day one. She was fed breastmilk and formula-fortified breastmilk until seven months, when I started having crying jags at the pump. The best thing for my mental health at that point was to stop pumping, but DD continued night and weekend nursing for another six months before weaning herself.
Despite this background, I believe that breastmilk is only a tiny bit best. Most of the advantages disappear if you correct for household income - it's like researchers discover over and over that more money = better pediatric outcomes, and proponents of breastfeeding read it and come out cheering for breast milk.
When I am asked for advice on infant nutrition, I say feed the baby an appropriate food. Don't break your heart or your health over breastmilk vs. Formula. love the baby, and make feeding choices that respect your needs and abilities without apologizing for them.

 

I'm glad you give advice you feel comfortable giving. You clearly work very hard to be the best possible mother you can be for your children.  They are lucky for that. 

 

Again, human milk is what is normal for human babies. Individual circumstances do not negate this fact. 

 

Humans have made it this far (until the last 100-150 years) drinking human milk, typically either from their mother or a wet-nurse. I do not need any study to prove to me that breastfeeding is the normal way to feed babies. I do not believe that we would be here today if everyone were as sick 500, 1,000, 5,000 years ago as they are today. Everyone has something & in some way is not healthy. Obesity, dental problems, allergies, asthma, addictions (be it to somethig or doing something), mental health issues, ADD/ADHD/ASD's, etc.  And even if a child doesnt have one of these in their first 5-10 years of life, they most likely will.  I do not think this means that people are fine but I realize others have different standards.

 

You are welcome to your beliefs.  I don't believe it's better, best, anything other than normal.  In my house, where we've steered clear of the doctors office, we've still managed to be pretty healthy (and this is in spite of compromised immune systems - my children have food allergies).  So, does that mean it's money or the breastfeeding?  (And, I don't need an answer.)

 

Sus
 

[MeepyCat]

Sus, I think a lot of things contribute to the health problems you see, but I think we had different problems back in history.

A hundred or so years ago, doctors invented baby formula so that women wouldn't feed their babies condensed milk and corn syrup. It was a major improvement in infant health.

Have you checked out childbed mortality stats for those years? Or infant mortality? How about life expectancies for the last 5000 years?

I admit that we might see less obesity and heart disease today if no one had ever invented the desk job, or the no-sidewalk suburb, but the species has been limping along with a collection of health problems for millenia. The things people used to get just from not bathing are hideous enough, and poor sewage infrastructure, and unpasteurized milk.... these issues predate modern infant formula, and even if you think formula is bad, these were worse.

A hundred years ago, my daughter wouldn't have needed any formula, and I wouldn't have been able to give it to her. We'd both have died on her birthday. Instead, I'm planning a third birthday for my evidently totally normal little girl. The upside of that hundred years ago scenario (if you can call it that) is, in that picture, I don't need treatment for breast cancer. Some of the increase we see in scary health problems is that, with better health care from the start, we live long enough to see them.

[MichelleZB]

Originally Posted by MeepyCat 
Despite this background, I believe that breastmilk is only a tiny bit best. Most of the advantages disappear if you correct for household income - it's like researchers discover over and over that more money = better pediatric outcomes, and proponents of breastfeeding read it and come out cheering for breast milk.

Can you back that up? I'm somehow skeptical that breastmilk only works out as nutritionally best when you don't adjust for household income in the study. I'm pretty sure it's better regardless of socioeconomic status.

Also, as long as we're talking money, breastmilk is free! And while I know that it is difficult to breastfeed if you are so poor that you need to go back to work immediately, that is usually not a problem in countries where mothers have about a year of government-supported mat leave.

One of the requirements of a baby friendly hospital is that they don't give out formula samples. It's not really a big deal to refuse to be a marketing tool for formula companies! I don't understand why there's so much backlash about the idea that hospitals should be hospitals, not advertisement vehicles. Mothers who really want formula samples can simply sign up for them on formula websites and be mailed them at home.

[MeepyCat]

Michelle, the best I can find on breast feeding and income right now is this:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1361236/ - a study in which comparisons were made between siblings in an attempt to determine whether variations between families were more significant than variation within families.  The only area in which these researchers found a lasting benefit to breast feeding was cognitive abilities.  I concede that that's a pretty major thing, however, the researchers note:

Our results also suggest, however, that many of the other long-term effects of breastfeeding have been overstated. The implication for breastfeeding researchers is that selection bias remains a serious problem even with controls for household income, family size, parental education, race, ethnicity, and other sociodemographic characteristics of the family. A productive direction for breastfeeding research lies in seeking data and methods to attack the selection problem. An implication for researchers interested in child outcomes unrelated to breastfeeding is that a child's breastfeeding history may nevertheless be a good proxy for unobservable family characteristics that are correlated with child outcomes.

Emphasis mine.

I will further note that breast milk is free only if you assign a value of $0 to a mother's time and physical presence.

There are lots of baby friendly hospitals, and lots of hospitals that haven't met the (IMO, somewhat absurd) criteria for official baby friendliness that nonetheless do not participate in formula marketing programs.  There's nothing wrong with that.  My objection is, and remains, that I do not believe that government needs to involve itself in a job that women and hospitals have been doing just fine for themselves.  I don't need the mayor to forbid the hospital to give me a formula gift bag - the hospital can turn it down on their own behalf, or I can abandon it in the hospital room if I don't want it.  I don't need Bloomberg to "protect" me and mine from the danger of a few coupons.

ETA:  If Mayor Bloomberg wants to give every woman in NYC a year of government supported maternity leave - something NONE of those women have now - I would be happy to get behind it.  Alas, that government supported leave doesn't exist in the US, and the lack of it undoubtedly has a huge impact on breast feeding rates.