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Protesting One of Breastfeeding's 'Booby Traps'

A couple of weeks ago, I found myself face-to-face with a common breastfeeding "booby trap," unnecessary formula supplementation in the hospital.  What was different this time was that I was not the lactation consultant but a family member of the newborn, which gave me more leverage than the lactation   professionals who work there.  For this reason, I felt obligated to write to the hospital's director of mother-infant services, and, yes, even the CEO.  When parents and other family members speak up, this is taken seriously because hospital administrators consider "patient satisfaction" high on their priority lists.  The letter below describes what happened.  Please feel free to borrow from it if you need to send a similar letter to your own hospital.  --Nancy

I’m writing to make you aware of an incident that occurred on March 6 in your newborn nursery after the birth of one of my family members, Baby LR, and to ask for your response. 

I was asked to come to the hospital as a support person when Baby LR was born because of my training as a lactation consultant.  When I arrived outside the newborn nursery where Baby LR had been brought after her birth by cesarean, the first thing I saw was the Patient Care Technician (PCT) explaining to Baby LR’s father, RR, that she would be feeding Baby LR a bottle of formula.  I saw RR tell the PCT that they were planning to breastfeed and ask her not to give the formula.  According to him, her response was “We know what we’re doing,” which was patronizing at best, followed by her assertion that she was following hospital policy.  She told him that because Baby LR was large-for-gestational age (9lb 6oz), she was required to be fed within one hour after birth and since her mother was not yet in her room and ready to breastfeed, Baby LR would be fed formula.

I saw no clinical justification for this practice.  Baby LR was full term, healthy, and completely asymptomatic.  No blood sugar test had been done, and she was at her mother’s breast within two hours after birth.  Because there was no obvious medical reason for this supplementation with formula, I went to the lactation consultant office for clarification.  The LC called the nurse in charge and was told that indeed this baby’s blood sugar had never been tested and that it was “policy” to give formula at one hour if she had not gone to breast.

Are you aware that two years ago The Joint Commission released a Perinatal Care Core Measure on exclusive breastmilk feeding?  Both The Joint Commission and the Centers for Disease Control and Prevention consider this best practice during the hospital stay and consider unnecessary supplementation with formula problematic because it leads to more negative health outcomes.  Hospitals are judged and rated by these organizations on how well their policies support exclusive breastmilk feeding.  If this is indeed a policy in your hospital, please explain its rationale.  Also, if you consider it vital for a baby to receive her first feeding no later than exactly one hour after birth, why did no one help put baby to breast right after delivery?

Even one bottle of formula changes a newborn’s gut flora, and it takes two to four weeks of exclusive breastfeeding to return it to normal.  During the most vulnerable period of life, this puts the infant at increased risk of gastrointestinal infection.  It also interferes with the immune system priming that occurs during the early weeks and exposes a newborn to the most common allergen (cow’s milk protein) while her intestinal walls are at their most permeable and she is at greatest risk of allergy sensitization.  This is a far-from-harmless practice, and if this baby suffers from any of these health problems, I will consider your hospital legally responsible.

I was told that your hospital’s goal is to become Baby Friendly.  If you are indeed considering applying for this important designation, please know that your worthiness for certification as Baby Friendly will depend on your staff giving formula supplementation only “if a medical indication exists.”  It appears to me there was no medical indication in this case.

I would appreciate receiving a response from you about this incident.  Obviously, it is too late for Baby LR to have the normal early feeding experience her parents had planned, but my hope is that you will reconsider this practice.  At the very least, I'm hoping that by speaking up I can help prevent this from happening to other families.

As a Board member of the Chicago Area Breastfeeding Coalition, I am often asked by parents for hospital recommendations.  Until this practice is changed, I will be unable to recommend St. Alexius Medical Center to parents seeking a breastfeeding-supportive hospital.

Sincerely yours,

Nancy Mohrbacher, IBCLC, FILCA


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    Breastfeeding Answers Made Simple - Breastfeeding Reporter - Protesting One of Breastfeeding's 'Booby Traps'

Reader Comments (19)

Thank you Nancy for speaking up!
-grateful L&D Nurse & mother

March 19, 2012 | Unregistered CommenterL&DNurse & Mom

What a fabulously worded letter. I'm just sorry it had to come on the heels of such a damaging experience. I hope the administrators sit up and take notice. Way to advocate for your family and for others' babies!

March 19, 2012 | Unregistered CommenterMama Mo

Please share the response of hospital. Im so curious if they think they can defend their incorrect actions. Thank you. Its women like you that stood up for me in the hospital. I will forever love my hospital angel stranger. She changed my daughters life as well as mine.

March 20, 2012 | Unregistered CommenterRenee

My twin delivery was via c-section after trying unsuccessfully to deliver vaginally. Due to complications with pain management when they were stitching me up (the epidural kept wearing off), they gave me a pain med that wouldn't allow me to breastfeed for 24 hours. I did however pump and dump that night. My twin girls were healthy, 6 and 7 pounders and born at nearly 39 weeks gestation. I had wanted to breastfeed as soon as possible but the night nurse told me they were going to give my babies formula. When I objected, she sneered "Well, do you want them to starve?". I found out later that babies don't really need to eat for even a couple days so it was unnecessary for them to feed my babies formula. I had the hardest time getting one of my twins to latch on and nurse. She always wanted the bottle as it was easier. I kept trying 9-12x a day to breastfeed (often tandem) but it was too hard and when they were 7 weeks old, I switched to pumping only and feeding them 2/3rd of the time my breast milk and 1/3 formula as I couldn't make enough milk to feed two babies. I regret letting that darn nurse intimidate me into feeding my twins formula so early on. Really messed things up for us. I wish I would have written the hospital (St. Lukes Roosevelt in NYC). Very dissatisfied with my patient care there. I actually left a day early (after 3 days vs. 4) as I knew I would get better care at home with my Mom than via the nurses at the hospital.

March 20, 2012 | Unregistered CommenterElizabeth

Thank you so much for this. So many moms are angry at hospitals for formula pushing/supplementing, but are to tired/busy with babies to write the letter. This type of letter should also be written to doctor's practices that sell mother's names to formula companies so you get the "complimentary" cans.

March 20, 2012 | Unregistered CommenterCrowmama

I have seen this practice even in hospitals that have labelled themselves as Baby Friendly. The excuses will keep circling around:"This baby is too big", "This baby is too small", etc. for the rules of exclusive breastfeeding from birth to apply. Until there is a punitive response for noncompliance with the Joint Commission's recommendations about exclusive breastfeeding, nothing will change. Today's nurses in the Mom/Baby units have rarely seen any newborn successfully breastfeed and really don't understand the process other than the lip service "breast is best" comment that is bandied about. Most women today still have not successfully breastfed their babies and it is because of non-supportive caregivers and health care providers that this is so. We need to develop a nationwide and worldwide culture that promotes breastfeeding and it needs to permeate to every single provider and every woman so that it is what is expected rather than the exception. Many today view breastfeeding as added trouble and unnecessary hassle and not for modern women who work and participate in a full life. The reality is that breastfeeding moms are more likely to have college degrees and are more rested than their bottle feeding counterparts but until we can bring the truth to full exposure, women will continue to experience difficulties in being allowed to completely breastfeed their babies. Please, Nancy, continue your advocacy. We will all do our part and perhaps soon see some positive change.

March 20, 2012 | Unregistered CommenterDeborah

Excellent letter. Please do post the hospital's response.

March 20, 2012 | Unregistered CommenterChristina

That is an awesome letter!! Wow!

March 21, 2012 | Unregistered CommenterKatie

They didn't know who they were messing with :) Thank you for speaking up, Nancy- I think if everyone did this, we'd see many more of these situations corrected, and a faster move toward truly mother and baby friendly practices. It is astonishing that they are going for Baby Friendly recognition with a policy such as this! Can't wait to hear what their response is.

March 24, 2012 | Unregistered CommenterMary

I am currently writing a book that tackles this topic, as you may remember Nancy (I interviewed you for it briefly last year. You were very articulate and helpful!). Moms all over the United States receive this kind of advice on a daily basis. I interviewed a doctor this week who is so frustrated by how the vast majority of health professionals continue to give women faulty, not-evidence based, and even rude advice. Asking a new mom if she wants to starve her baby is emotional abuse. Yet this coercive Soviet-style tactic is considered completely acceptable when a labor nurse or a pediatrician wants to undermine a woman's evidence-based desire to feed her own baby with her own milk. And then we wonder why our infant mortality rates are among the highest in the industrialized world? Have you received a response to your excellent letter? I am eager to hear what they have to say.

April 5, 2012 | Unregistered CommenterJennifer Margulis

Wow! I delivered at st alexius, and being a new mom and breastfeeding i didnt know what to expect. I had a similar experience, say two after baby was born the nighttime nurse told me she was dehidrated because my milk didnt come in and insisted in giving formula. Working on no sleep and not having a clue, i said ok. For a month i supplimented because i left the hospital with the idea that my milk wasnt enough and my baby was starving. i am proud to say that i learned that wasnt the case and i was all my baby needed. She is now ebf and we love it.

April 6, 2012 | Unregistered Commenterchristie

I am so happy you took the time to write this. I warn about this very scenario over and over. I, too, will be anxiously awaiting their reply. @response who could not breastfeed for 24 hours due to pain medication. I'm not sure what that would be - must be otherworldly. Most commonly used pain medications are compatible with breastfeeding. I would take them to task for giving a breastfeeding mom a medication that was not compatible with breastfeeding. That is, to me, is as horrific as giving a patient a medication they on their allergic list. No excuses.

Nancy, thank you for speaking up and sharing this letter. I'm sorry for the healthcare system's failure to see beyond "habit" aka "policy" and not recognize best practice - and even more simply than that - the failutre to do the right thing. We should always run our "No" through filters before we tell an adult patient or family member "No". Sometimes the answer is "No" - but we need to filter and double-check and be able to explain our response to their satisfaction. With modern technology, hopefully, we can now educate more than one by one! I, too, am anxious to learn of the response from the hospital. I've copied your letter and it is being circulated here in our nursery, post-partum, and L&D areas.

I am so sorry your family members had to experience this. It is amazing that you are here as their advocate, and an advocate for all nursing moms having hospital births. Compare this experience with that of Serena Tremblay (story available in the link: whose nurses went well above the call of duty to help her achieve her goal of nursing her newborn son. With proper education, such as you provide, all medical professionals might do what is best for mom and baby, rather than blindly following hospital protocols.

April 14, 2012 | Unregistered CommenterNancy Kelly

It always is amazing to me exactly how site owners such as your self can find enough time as well as the commitment to carry on composing good blog posts. I simply needed to say thanks

April 25, 2012 | Unregistered Commentermothers milk

I hope you receive a response from the hospital. My son was also given formula because he was 10 lbs 10 oz. I have a history of large, healthy babies, as my daughter was 10 lbs as well. I was not at all pleased, but the nurse told me that if I wouldn't give him the formula, they'd have to take him to NICU. What a joke!

April 27, 2012 | Unregistered CommenterBecki

My son was born in a birth center, he was 9lbs. He was breathing very fast so we transferred to the local NICU to check him out. He was fine by the time we got there. But then the head NICU nurse started going on about how he "had" to take a bottle, I told her no he didn't I was there. Then she said "you can't sleep here!" ok, I won't. (I actually got a room downstairs but didn't sleep for 24 hours until they let him come down to my room, I basically sat up there guarding him whenever I could but I had to leave for shift changes and to eat/potty). Later they told me he "had" to use a pacifier. I couldn't believe how crazy the NICU nurses were. Fortunately the nurse on my floor was great, one of the first things she asked me was if I would like a pump, and then brought me the large flanges when she saw the regular ones were not going to work for me (I didn't even ask). The outgoing paperwork said he was receiving a mix of formula and milk, that was news to me, but I suppose it was just a standard form and they didn't really verify it. I thought about writing a letter, but I was tired, didn't know who to send it to, and was dealing with a newborn who had a tongue AND a lip tie (that with all those nurses including me asking specifically about his latch to two "LC's" didn't find) I just never wrote it...

November 1, 2012 | Unregistered Commentertash

29 years ago my 2nd child was 10 lbs born at home, I successfully totally breastfeed him for 9 months when he took a glass of carrot juice from me to taste, so we started adding solids. At 5 months he weighed 22 lbs just on breastmilk. We continued to breastfeed throughout my 3rd pregnancy and he weaned himself just before he turned 3 and his sister was born one week later.

March 2, 2013 | Unregistered Commentermsdegas

Thank you, Nancy. New parents are so vulnerable and easily mislead by well-meaning, yet task-oriented hospital staff members.
We need policies that protect newborns from unnecessary formula supplementation - unless there is a true medical indication. Pediatricians need to order any/all formula supplementation and the medical necessity for that supplementation. Parents need to be told the risks of formula supplementation. Amy Harvick, ARNP, CCE, IBCLC

March 2, 2013 | Unregistered CommenterNancy Mohrbacher IBCLC
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