The Dangers of Formula - Page 9

[annettemarie]

Speaking of watching our language we've kept it civil thus far. If we could continue doing so, it will go a long way in keeping this thread on the boards. So, if we could lose the sarcasm and the "this place sucks"-type posts all around, that would be great. /modliness

[BugMacGee]

Wow, you are really, really lucky to live where breastfeeding is the norm then. That must mean you have a 99% initiation rate, similar to Norway. It must mean that the first go-to intervention in your hospitals isn't formula for everything from baby's getting a tad jaundiced to baby blinked twice more than he was supposed to. It must mean that during pediatric checkups, moms are not asked how much formula is the baby drinking now? Or, you can put her on cow's milk now that she's one? Or, he's still nursing? Or, here, take a can, just in case? It must mean that you can walk into a mall or restaurant and see women with babies nursing instead of women mixing bottles of formula. You must see it on tv and in magazines - not just in PSA's or as a butt of the joke for the night, but as part of what is done. A woman with thrush or mastitis must be able to go to her doctor and have it both diagnosed and treated without being told she has to wean. Sounds like Lactopia. Wish I lived there.


We had a 91 % initiation rate (see a few posts back) in 2004 according to the CDC. Our intervention is to use LC's since most of the mat/nursery nurses are trained in BF education. Many are dedicated lactivists in their own right. In our NICU, we have to have an order for formula. With Hyperbilirubinemia, Mom gets a hospital grade pump and nurses as much as possible. IF her milk isn't in and bili is high they do IV fluids on top of BF'ing, IVIG if it's very high, formula as a last resort. My personal peds (I've had 2) don't bat an eye that I'm still BF'ing. One encourages BF'ing through exams. I've gone to births where the peds put meconium babies to breast while they assess them. I've not been to every ped, but I worked for 6 years in the biggest pediatric training hospital in the region. Breastfeeding is what they are taught.
Mom's have to sign consents for formula in both the hosptials where I've worked.
We have nursing rooms in the mall, but I still see women BF'ing in the play area (and how do you know that what's in a bottle isn't breastmilk unless you actually saw them mix it?)
Good friend had mastitis, got abx and nursed through it. I'm sure not all women do that but that's what I know. Sister had thrush, did GV and nursed through it (again, that's my experience). Not Lactopia but far from Formulopia. Considering the huge mix of cultures represented, I think we're doing quite well.

[BugMacGee]

Cultural smokescreen or not, it gets the job done. At least with the moms I have the priviledge to help breastfeed.

BTW did I mention that I love CD's yet?

[My4Boys]

Originally Posted by BugMacGee

We had a 91 % initiation rate (see a few posts back) in 2004 according to the CDC. Our intervention is to use LC's since most of the mat/nursery nurses are trained in BF education. Many are dedicated lactivists in their own right. In our NICU, we have to have an order for formula. With Hyperbilirubinemia, Mom gets a hospital grade pump and nurses as much as possible. IF her milk isn't in and bili is high they do IV fluids on top of BF'ing, IVIG if it's very high, formula as a last resort. My personal peds (I've had 2) don't bat an eye that I'm still BF'ing. One encourages BF'ing through exams. I've gone to births where the peds put meconium babies to breast while they assess them. I've not been to every ped, but I worked for 6 years in the biggest pediatric training hospital in the region. Breastfeeding is what they are taught.
Mom's have to sign consents for formula in both the hosptials where I've worked.
We have nursing rooms in the mall, but I still see women BF'ing in the play area (and how do you know that what's in a bottle isn't breastmilk unless you actually saw them mix it?)
Good friend had mastitis, got abx and nursed through it. I'm sure not all women do that but that's what I know. Sister had thrush, did GV and nursed through it (again, that's my experience). Not Lactopia but far from Formulopia. Considering the huge mix of cultures represented, I think we're doing quite well.

Sounds wonderful.

Where I live, we have a 76% initiation rate. Not bad, but by 6 weeks we are down to around 30%. In the past week I have seen two babies with obvious tongue tie that will go unclipped becuase the peds do not believe it affects breastfeeding. I helped a mother explain to her doctor why the routine administration of glucose to her c-section baby to prevent hypoglycemia was unwanted by her and unnecessary on his part. I spoke to three mothers who were told to wean so they could take anti-biotics - one for mastitis, one for strep, I don't remeber how the other woman was dx'd. I do not know a single woman who has given birth in a hospital in my area whose child did not have formula or glucose water administered for one reason or another - even in the hospitals that employ IBCLC's. While my experience of not knowing anyone who leaves the hospital EBF'ing doesn't mean that no one ever leaves EBF'ing, it certainly shows a trend toward a high rate of unnecesary formula intervention.

In our entire state there is not one single baby friendly hospital. There is one chain of hospitals with a decent lactation program that uses IBCLC's - the rest either have nothing, or use a three hour program and deem their RN's RNLC's.

I have personally been told by peds that breastfeeding is "OK", "nothing to get excited about", "fine if you can do it". I have been told, of my then 14 month old, that it was time to wean him. I was ordered by one ped to give my 3 week old a bottle so he would get used to it "in case you die".

Outside of the context of nursing mother support groups, I've seen three moms in the past 5 years breastfeeding. While I am sure some moms are using expressed milk instead of NIP'ing, not seeing it equates to it not being normal.

If I lived in an area where the medical establishment got it, where they understood breastfeeding, knew how to manage it or who to refer to, or actually believed it was better (much less normal), I would believe that telling moms breast is best was working. Because I do believe that the breast is best message is great for moms. It's just not doing anything for those in a position to make any real changes to the duration rates. Which, I believe, was what the original, long lost point fo this thread was about - getting the medical establishment to get it. Sounds like where ever you live, they get it. Here, they're not even close.

[the_lissa]

Originally Posted by songbh

I think you are misunderstanding this point, which is about how we turn raw statistical data into "plain English."

Let's say, for example, that a study of 1000 exclusively breastfed babies and 1000 formula-fed babies finds that 10 of the breastfed babies suffered a certain illness and that 20 of the formula-fed babies suffered that same illness.

How do we compare those data? Do we say that breastfeeding lowered the rate of that illness by 50%? Or do we say that formula-feeding increased the rate of that illness by 100%?

Both those statements are factually accurate. But the "starting point" of each calculation conveys what the norm is considered to be. Time and again, such studies are written as if formula-feeding is what is normal for babies, and so they conclude that "breastfeeding lowers the rate by 50%."

If they were written instead with breastfeeding as the norm -- the starting point -- then the conclusion would be phrased, "Formula-feeding increased the rate by 100%."

Which number sounds more impressive -- 50% reduction or 100% increase?

This is the level at which cultural norms and assumptions dramatically shape -- through language usage, through message framing -- the deep, almost subconscious beliefs people hold about infant feeding behaviors.

This is also how your stance ends up, whether you intend it to or not, supporting the continuation of normalized formula-feeding. As Weissenger says in her "Watch Your Language!" essay:

Great post.

It is not opinion. It is biological fact. Breastfeeding is the biological norm. It cannot decrease a risk of cancer. Deviating from the biological norm increases the risk of cancer.

Another example is smoking. Let's say, for example, that a study of 1000 non smokers and 1000 smokers finds that 10 of the non smokers suffered a certain illness and that 20 of the smokers suffered that same illness.


How do we compare those data? Do we say that not smoking lowered the rate of that illness by 50%? Or do we say that smoking increased the rate of that illness by 100%?

[songbh]

Originally Posted by KirstenMary

For many women, there is no cultural smokescreen. ... I am referring to the emotional investment women make in their choices, choices that are supported by the medical professionals on whom they rely.

Our emotions about our parenting practices are deeply tied up with what our culture considers to be normal and admirable. And medical advice is also heavily influenced by the culture in which medical professionals live and are trained. So I would contend that these things are precisely part of the cultural smokescreen that is making it so hard for you to hear "formula is risky" as a valuable and effective BFing promotion tool.

Telling a FFing woman that she could be killing her baby with formula will accomplish...what?

To repeat something I posted earlier in this thread:

Originally Posted by songbh

Why do you assume that FFing mothers are the target of breastfeeding promotion? ... I think the target of lactivist discourse should be, first and foremost, the policymakers and budget-planners of government, industry, medicine, and education. After that, society at large -- the kind of folks who see public ad campaigns when done properly and not hamstrung by an unethical formula industry and a compromised AAP -- in other words, everyone who watches TV or sees billboards. Third, I would target America's schoolchildren, female and male alike, through health education curricula. Fourth, every student in medical or nursing school. Fifth, pregnant women.

Mothers who already are not breastfeeding don't even make my list for BFing promotion campaign targets. Not that I want them to feel left out or anything, just ... you know ... logic?

Finally, I'd like to address this question, which implies that I must be a very cold-hearted vindictive person indeed to argue for framing non-emergency routine formula usage as risky:

Will it make you feel better that you gave her the facts in the correct manner? Great. But I highly doubt your words will have the intended effect.

A) I wouldn't target this message at mothers who already are not breastfeeding to begin with; B) my breastfeeding advocacy work is not about making myself feel good.

Just to set the record straight.

[Breastfeeding Insomniac]

Originally Posted by KirstenMary

I would rather promote the benefits of breastfeeding. Pointing out FFing dangers had the potential to put FFing moms on the defensive, and that accomplishes nothing.

I actually think that is is best to inform mom of formyula dangers, so she can truly make an educated choice. a lot of moms get such watered down info on the subject that they often think of it as formula is to breastmilk as generic is to name brand. If moms truly knew the dangers, I think there would def be a higher initiation rate.

[songbh]

Originally Posted by delphiniumpansy

I think it is a good point to look at what the research shows about advocating breastfeeding and risks. LLL has a page which says that, in fact, it is better to talk about the risks, that they do increase the likelihood of breastfeeding.

http://www.llli.org/NB/NBSepOct05p208a.html

So, I stand corrected. But, I will say, that I do think in-your-face advocacy is annoying. So, be polite.

ITA. Thanks for this post, and for the New Beginnings link.

[KirstenMary]

Originally Posted by My4Boys

Who is talking about telling a FF'ing woman that she could be killing her baby with formula? Who? Where was it stated that the intentions of any person on this forum wants to go up to a FF'ing mom and tell them they are killing their child? We are talking about making cultural changes at a societal level, not about taking individual women by the hand and berating them for their choices. Unfortunately, yes, to make those cultural changes, individual FF'ing moms will end up hearing things they don't like. But NO ONE wants to tell a mother she is going to kill her child by FF'ing.

(Although I've had a doctor tell me I was going to kill my child if I continued to co-sleep - but hey, oranges and apples, right?)

If you FF your child, your child will have a lower IQ.
If you FF your child, you are increasing your child's risk of cancer.
If you FF your child, you are exposing your child to a multitude of deadly contaminants.

Sure, you can phrase it that way, but a FFing mother is going to hear, "Formula is killing your child."

[KirstenMary]

Originally Posted by songbh

I'm currently reading James Akre's The Problem With Breastfeeding, which, despite its misleading/annoying title, is a nice little book about precisely this problem: how (and WHY) to change broad public awareness to understand that breastfeeding is normal and that non-emergency routine formula-feeding is risky.

He makes a fairly convincing globally-oriented argument that this mainstream awareness of the risks of non-emergency routine formula use is the critical piece of the equation for better (i.e. closer to meeting WHO recommendations) breastfeeding rates. In other words, this is a problem of culture -- that realm of generally accepted assumptions, unspoken rules, mainstream taken-for-granted behaviors.

It is frustrating to see such a dead-on pertinent lactivist question be raised only to be immediately and thoroughly diverted into the same-old same-old non sequitors and re-spin derived, consciously or not, from formula marketing frames and buzzwords. "Guilt" and "choice" and so on. The OP's question was about doctors informing their pregnant and newly postpartum patients about the risks of unnecessary formula use. Doctors. Not the busybody lady in the food court, not the know-it-all MIL or neighbor. Doctors, whose business generally is considered to be the health of their patients. Doctors, whose business generally is NOT considered to be preventing the onset of "guilty feelings" in their patients.

Would a set lecture delivered by a doctor to each pregnant woman in this country improve breastfeeding rates? By itself, probably not. But it would be a step in the right direction, especially if it was accompanied by getting the formula marketing OUT of those same doctor's offices and out of the hospital maternity wards. And to have the full power and righteous authority of the medical establishment 100% behind breastfeeding instead of the weak-kneed lip service that is more typical of that profession would also go a long ways towards convincing the politicians and CEOs and insurance companies that protecting, promoting, and supporting breastfeeding is a smart investment of capital -- financial, social, and political.

But nooooooo. Instead we repeat here ad nauseum the same downwardly spiraling did-too did-not "what about my cousin Millie" discussion that leads us time and again into the terrain of irreconcilable anecdotes describing personal "knowledge" with zero consideration for how one's personal life, including one's beliefs, choices, and values, is shaped by larger historical, political, economic, and cultural forces.

Blech. Maybe I'm just grumpy from grading too many bad term papers. But this is frustrating.

Again, I have read your evidence. It's all still.opinion.

I'll tell you what would change my mind. Find me a study done by an impartial party wherein a large selection of feeding method-undecided pregnant women were explained their feeding choices. Educate one group about the dangers of formula, and educate the other group with the same information, but phrased as benefits of breastfeeding.

If, after comparing the results, the women who were explained the dangers of FFing had a higher rate of BFing, I would gladly change my tune.

[KirstenMary]

http://www.llli.org/NB/NBSepOct05p208a.html

That's the kind of thing I am looking for, but I want to see the study.

[JessBB]

I personally cannot believe that there is any mother, ANYWHERE who would want to be denied information that could protect their child simply because it might hurt their feelings. As an attorney, that MDs don't disclose formula risks (which is what they are, not breast milk "advantages") is very alarming to me from a informed consent perspective. There are more warnings on a hair dryer than on a can of formula!

IMO, this issue stems in large part from the beneficiaries of the information - women and children. There are clear biases in the medical-industrial complex against the diagnosis and treatment of all minority groups. I think the lack of care paid to breastfeeding is emblematic of that. Add this to the generally paternalistic attitude of many physicians, whereby patients, esp. women, cannot be trusted to make good decisions. Also, as has been said ad nauseum, there is no money to be made in breastfeeding .

I realize from the tenor of this thread that this is a sensitive issue. Believe me, I get that - my best friend and my ds's godmother ff's by choice. I would never, ever attack her, not least of all because she did not make a knowing, informed choice based on all the scientific information - because NO ONE made that information available to her. Don't moms and babies deserve the whole and unvarnished truth?

[KirstenMary]

Originally Posted by JessBB

I personally cannot believe that there is any mother, ANYWHERE who would want to be denied information that could protect their child simply because it might hurt their feelings.

I'm not worried about feelings; my concern is about affecting choices in the best way possible.

[JessBB]

Originally Posted by KirstenMary

I'm not worried about feelings; my concern is about affecting choices in the best way possible.

Meaning that offending or putting ff moms on the defensive might undermine lactivists' ability to influence them? I suppose I agree with that on a micro level - if I upset my friend she is likely to ignore me in the future. However, on a societal level, I find the "prevent guilt" tack to be paternalistic and offensive - women would knowingly disregard firm scientific evidence to protect their children because it makes them feel guilty? No one would ever say that men shouldn't be told about cholesterol because it might make them feel "guilty" about bacon double cheeseburgers. I think that women should be trusted to make the right decision based on all the information. And I think that doctors and the FDA are the ones primarily responsible for making that happen.

[Tine]

Originally Posted by KirstenMary

If you FF your child, your child will have a lower IQ.
If you FF your child, you are increasing your child's risk of cancer.
If you FF your child, you are exposing your child to a multitude of deadly contaminants.

Sure, you can phrase it that way, but a FFing mother is going to hear, "Formula is killing your child."

FF mothers are not the audience!

For the purposes of this debate, FF moms are irrelevant.

I must say, it is mightily frustrating to keep hearing this claim that anyone wants to tell FF moms they're killing their children.

For the (...I dunno...20th?...) time: Those who support the "risks of formula" campaign want this info given to BF and undecided moms.

[annahawk]

I wish that OBGYNs would do more to educate their patients about the facts concerning BF/FF. By the time you get to the pediatrician it's usually too late. Parents have already chosen and begun their method of feeding. If someone is in the office with their exclusively formula fed two month old, they can't just start lactating again. I think this is the problem often. People don't really get into the discussion typically until after the baby is born. Then what's a FF mom to do? No wonder they go on the defensive.

But personally I do find it amazing when I see formula ads even on benign things like pens and floor mats. Really, you don't have to bash it, but don't promote it!
I too, wish people would see BF as the norm and FF as 2nd choice. Breastmilk is not some above and beyond advandtage. It's what your child is designed to eat. And we don't have to run around with our mouths shut acting like formula is just as good. You don't have to be pushy or offensive to be truthful. It's all in the attitude of the approach.

I actually found a nice surprise when I was searching for a place to deliver my son. On the University of Tennessee medical center website there is a pregnancy and birth manual called Joy, A Guidebook that actually lists all the risks a formula fed baby is prone to and what they will miss if they don't receive breastmilk. It also asked the question, Who should breastfeed, and answered with everybody except HIV positive moms. I was really surprised how direct a major medical establishment was about it. Wow.

[songbh]

Originally Posted by KirstenMary

Again, I have read your evidence. It's all still.opinion.

Whatever. I won't get sucked further into a pointless "is-too/is-not" squabble with you over the difference between scholarly peer-reviewed research and knowledge based solely on one's personal experience.

However, given your views on the "just-more-opinion" nature of scholarly research, it is particularly baffling that in the very next breath you then request this:

I'll tell you what would change my mind. Find me a study done by an impartial party wherein a large selection of feeding method-undecided pregnant women were explained their feeding choices. Educate one group about the dangers of formula, and educate the other group with the same information, but phrased as benefits of breastfeeding.

If, after comparing the results, the women who were explained the dangers of FFing had a higher rate of BFing, I would gladly change my tune.

I'll keep my eyes peeled for such a study. I don't know if it exists or not. I think it would be an interesting one to read, and I hope it gets done if it hasn't already been.

However -- the fact that this particular study is what would convince you that "risks" discourse would be effective in improving breastfeeding rates is further evidence that you still aren't grasping or engaging seriously with the cultural argument many of us are making in this thread.

The cultural approach to changing the way people think about breastfeeding specifically rejects the idea that it's just a question of getting the right message out to the mothers of infants. It should be obvious to anyone involved in breastfeeding advocacy, support, or education that mothers by themselves, no matter what they know or don't know about breastfeeding, cannot as a group carry the entire societal burden of breastfeeding. If you educate pregnant women about the risks of non-emergency routine formula usage and then plop them all into the standard-issue maternity ward in the U.S., and then send them home with the standard-issue formula samples, and equip them all with the standard nonexistent paid maternity leave, and surround them with the standard-issue well-meaning-but-ignorant relatives and friends ... very few of them will still be breastfeeding a few months down the road.

Societal attitudes about breastfeeding have to change from "it's nice if you can swing it but don't expect me to cooperate" to "it takes a village and I'm willing and able to do my part to help." How do we get mainstream societal institutions and actors to give a shit about breastfeeding? By discussing the costs of breastfeeding failure and making sure everyone understands how much is at stake for our society's health and well-being. This is why I said upthread (twice, no less) that pregnant women come in maybe 5th on my list of targets for "risks of not breastfeeding" campaigns, after policymakers, budget-writers, the average Joe/Jane, schoolchildren, and medical/nursing students.

[BugMacGee]

Then I'm confused. Why the heck would BF'ing moms care about the risks of formula. Why are moms who are already BF'ing the audience? If you're preaching to the proverbial choir, I'm sure whatever tact you take will work wonders.

Isn't the point of breastfeeding promotion to try to get more moms to BF to begin with?

[songbh]

Originally Posted by JessBB

IMO, this issue stems in large part from the beneficiaries of the information - women and children. There are clear biases in the medical-industrial complex against the diagnosis and treatment of all minority groups. I think the lack of care paid to breastfeeding is emblematic of that. Add this to the generally paternalistic attitude of many physicians, whereby patients, esp. women, cannot be trusted to make good decisions.

Ding-ding-ding-ding!!! We have a winner, folks.

NOW we're talking l-activism.

I need a "high-five" smilie.

[laohaire]

Originally Posted by BugMacGee

Then I'm confused. Why the heck would BF'ing moms care about the risks of formula. Why are moms who are already BF'ing the audience? If you're preaching to the proverbial choir, I'm sure whatever tact you take will work wonders.

Isn't the point of breastfeeding promotion to try to get more moms to BF to begin with?

Well, I didn't see anything saying BFing moms were the audience.

But FWIW they are still an audience, more so than FF moms, and here's why.

Intiation rates may start out high. But a lot of moms stop BFing for one reason or another. They switch to formula.

I'm going to go out on a limb here and suggest that most formula babes have been fed at least some breastmilk before switching (I'm basing this assumption on reading initiation numbers consistently above 50%).

So, yes, reinforcing BFing moms to continue BFing even when they might be considering switching, would be a very valuable campaign.

So they along with pregnant moms, HCP and society as a whole (i.e. so your sister, MIL and your best friend all get the importance too, so they can quit their unsupportive statements) would be the audience. I don't think I could say which of those would be the single most important - probably a mixture of the first 3.