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

Thanks to my online contacts, within 2 hours 12 local mothers had volunteered to talk to this reporter. I had high hopes, but the article was a disappointment.  Formula company spokespeople were given the last word, noting that “it’s good to have a back-up” and characterizing it as “irresponsible” not to give new mothers free formula in the hospital.   

What was not reported was the true cost of this “free” formula to parents and the impact of hospital formula marketing on breastfeeding.  The most recent study on the effect of hospital distribution of infant formula  found that the mothers who received formula samples at discharge were less likely to be exclusively breastfeeding during each of their baby’s first 10 weeks as compared with women who did not receive them.  For a summary of decades of research on this issue, click here.

What’s most important for parents to know, though, is that this is not just about breastfeeding.  The reason formula companies work so hard to establish these unholy alliances with hospitals is that they know from their own research that due to fear of adverse reactions, most parents will continue to buy the formula their baby is given first. 

The “free” formula included in those stylish marketing bags is each brand’s most expensive type.  A cost analysis done by the outstanding nonprofit organization Ban the Bags found that formula-feeding families who use the high-priced formula in these marketing bags will spend $700 more during their baby’s first year than if they bought the generic store brand.  This is the true cost of these bags to families.  No wonder formula companies are so anxious to get this product into their hands! 

What’s in it for hospitals?  In many cases, in exchange for acting as formula marketing agents (and therefore endorsers of infant formula) hospitals receive unlimited free formula for their use.  And when formula flows like water on maternity floors it’s more likely to be fed to newborns unnecessarily to the detriment of breastfeeding: a double benefit for the formula industry. 

How can we convince hospitals that it is inappropriate and unethical to give formula samples to new parents?  In many ways, as Ban the Bags points out, this practice is like giving out free Big Macs on the cardiac floor.  Babies who receive infant formula have poorer health outcomes and higher health-care costs than exclusively breastfed babies.  It makes far more sense for hospitals to focus their energies on marketing health, not commercial products.  Click here for some ideas from Ban the Bags on how to sell this idea to your local hospital.

One last thing.  If you received a formula marketing bag from your local hospital, don’t forget to write a letter of complaint to the hospital's administration.  Patient satisfaction has a huge effect on hospital policy decisions.  Use your influence for the benefit of all new parents.

When I published my post, I was flooded with invitations from LLL Leaders and Area administrators who warmly welcomed me and extended their unconditional support.  So many people wrote that it was impossible for me to respond personally to them all.  If you were one, please accept my deepest thanks! 

Although I had many LLL Areas to choose from, I decided what was most important to me was not the quality of its beaches (as one Florida Leader offered as an incentive) but whether my presence was likely to bring the LLL International (LLLI) hammer down on my new Area.  I did not want to join a new team only to make their lives miserable by becoming a liability. 

So when I received an invitation from LLL of Connecticut, I knew that this was a match made in heaven.  These amazing ladies have become known for standing their ground against unreasonable LLLI policies and directives.  Of course, disagreeing with LLLI’s administration these days is almost guaranteed to result in sanctions and threats, so when the LLL of CT Area team made its concerns known publicly, LLLI wrote them a letter accepting their resignations, which they had not offered.  But LLL of CT has long been registered as its own nonprofit organization with the team as its legal representatives.  This allowed them to thumb their noses and continue their work.  They also bought their own liability insurance, so that could not be used as a weapon against them.  When LLLI tried to convince other CT Leaders to take their places, these Leaders made it clear that this team had their full support.

I have a feeling I’ll fit right in with LLL of CT, which just yesterday became my official LLL Area.  After all, as the saying goes, “Well-behaved women rarely make history.”  As you might expect, my opinion on the issue that led to my actions has not changed.  If anything, I am more convinced than ever that LLLI’s directive that Leaders must choose between LLL and BFUSA is divisive and therefore destructive to breastfeeding. 

In recent weeks, people on the inside have confirmed that the goal of this directive is to undermine BFUSA, which includes ex-LLL Leaders among its founders.  LLLI is headed down a slippery slope.  In Illinois, nearly half of its Leaders have resigned in the last two years.  It’s clearly time for it to look in the mirror and reevaluate its Leadership and its strategies.

I heard that one aspect of my actions was particularly upsetting to LLLI: my announcement on Facebook about my new BFUSA Breastfeeding Counselor status.  Should I take this to mean that it’s all right for LLL Leaders to be involved with both organizations as long as they don’t say so publicly?  Can we expect this to become LLLI’s version of “Don’t Ask, Don’t Tell?” 

If LLLI wants to grow and thrive, booting out those who question it is exactly the wrong approach.  LLL Leaders have never been easily cowed.  Those who breastfeed long term are clearly comfortable following a different drummer.  They are not women who can be bullied into following directives that are obviously wrong.  Take it from one who knows… or ask the Leaders in my new LLL Area.