No Such Thing as a Free Lunch

Not long ago I was contacted by an Associated Press reporter who asked for my help with an article she was writing on formula marketing by U.S. hospitals.  She asked me to provide contact information for women whose babies had either been given formula in the hospital or who were given formula marketing bags on discharge.  This was not hard to do, as according to the U.S. Centers for Disease Control and Prevention, 25% of breastfed babies receive unnecessary formula supplementation during their hospital stay.  And a recent article in Pediatrics estimates that 72% of U.S. hospitals distribute industry-sponsored formula sample packs to new parents  

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.

Our Amazing Network

Yesterday morning my new grandson, Jakub Carl Mohrbacher, entered the world at 7.5 lbs.  After 24 hours of labor with her first baby, my daughter-in-law Ania realized her dream of a natural, unmedicated water birth.  One my gifts to her was the services of a labor doula, Ayla, who was invaluable to Ania in managing her contractions.

I feel grateful today to Ayla, Ania's nurse-midwife Margaret, and my entire birth and breastfeeding network.  I livANIA & JAKUBe in the Chicago area and my son Peter and Ania live in Atlanta.  Ania’s mother will be the first to arrive at in Atlanta on Thursday to provide round-the-clock help to the new family.  When she leaves, I’ll fly there to spend two weeks as their helper at the end of July.

In other words my connection to them in the last two days was strictly by phone, e-mail, Skype, and text.  But I played an active role.  When Peter told me Ania was initially having trouble getting little Jakub latched on well, I made a phone call to the lactation department of her hospital and asked them to please look in on her, leaving her room number on the message.  With their permission, Ruby, the hospital LC, was kind enough to call me and report back after she saw them.  Fortunately, Ania needed just a little tweaking to get Jakub nursing well.  When a resident walked into their room and mentioned the possibility of separating mother and baby, I began calling all the lactation consultants and mother-to-mother breastfeeding support people I knew in Atlanta to get a recommendation for a breastfeeding-friendly pediatrician they could request in the hospital.  That situation turned around quickly and now no separation is planned. 

My son Peter on Father's DayI offered to schedule a home visit on Tuesday after hospital discharge with Claire, a private practice lactation consultant.  Peter gladly accepted this offer as a way to set their minds at ease. 

Today I extend my gratitude to Ayla, Margaret, Ruby, and Claire, to all I spoke to who gave me help and encouragement, as well as everyone else who touched the lives of my family.  I also give thanks for everyone everywhere who helps birthing and breastfeeding mothers. 

As I did my best to help Peter and Ania navigate these hurdles and to smooth their way, I couldn’t help but also think of  the many new mothers who are not connected to this amazing network and who struggle alone and unaided.  My fondest hope is that someday every new mother will get the help and support she needs.

Baby Friendly Hospitals Will Improve Black Breastfeeding Rates

This guest post comes from a fellow blogger I never miss, Elita (www.Blacktating.com).  It describes how a hospital’s Baby Friendly status affects breastfeeding initiation rates among Black mothers.  Similarly, a 2006 Australian study found that when breastfeeding rates there reached “universality” (in this study 96%), mothers of all ethnicities, education levels, and socio-economic status breastfed at the same rates.  In other words, once our institutions truly support breastfeeding, all women breastfeed equally.  Not surprising.  After all, we are mammals. --Nancy

A new update on California's breastfeeding rates and hospital policies was released by the California WIC Association and the UC Davis Human Lactation Center. The report, titled "One Hospital at a Time: Overcoming Barriers to Breastfeeding" takes a look at how instituting baby-friendly practices at Photo credit: edenpictureshospitals through California has impacted the breastfeeding rates.

California is currently home to 34 of the 150 hospitals and birth centers that have been certified as Baby Friendly by UNICEF/WHO. The report paints a very clear picture of how beneficial the Baby Friendly initiative has been to California's breastfeeding rates. Not surprisingly, the hospitals with the lowest breastfeeding rates are those that serve low income women of color and throughout the state, disparities are evident. The report states that in the past, these disparities were chalked up to differences in cultural practices, but the data clearly shows that hospitals that have baby-friendly policies in place were able to greatly reduce those disparities.

The report shows that the breastfeeding initiation rate throughout California for African-American women was at about 78% while the exclusive breastfeeding rate was around 40%. When you look at the exclusive breastfeeding rate for African-American women at the Baby Friendly hospitals, that number jumps from 40% to 60%. And although those numbers are still too low, they are far and away better than the national initiation rate of 54%.

We can also see the benefit of the Baby Friendly Hospital Initiative to African-American women in another state, New York. In New York City, all public hospitals are managed by Health and Hospital Corp., or HHC. HHC has encouraged its hospitals to incorporate all of the Ten Steps to Successful Breastfeeding, but only one, Harlem Hospital, has been certified as Baby Friendly.

Harlem Hospital serves a large population of African-American and African immigrant women. Any hospital that thinks becoming certified would be too difficult or wouldn't work with their population, need only look at Harlem Hospital as proof that it can be done anywhere. In 2007, right before officially becoming Baby-Friendly, 81% of women were breastfeeding when they left Harlem Hospital.

In a recent article in Heart & Soul magazine, a black woman who gave birth at Harlem Hospital talked about her experience. Alicia Lewis-Howard was told by family and friends that breastfeeding would hurt and she didn't think she would nurse for more than a month, but ended up breastfeeding for 6. She credits the nurses at the hospital with showing her how to properly latch the baby on so breastfeeding was not painful and for educating her on the many benefits of breastfeeding both to herself and her baby.

The Baby Friendly Initiative has been proven to increase black breastfeeding initiation and exclusivity rates. It is imperative that healthcare facilities that serve a large population of African-American women begin implementing as many of the Ten Steps as possible. Although the process of becoming Baby Friendly is extremely rigorous, there is no reason that hospitals can't make the smaller changes, like ensuring that all women are breastfeeding within an hour of birth and rooming in with their babies. If we want to see black breastfeeding rates improve, we have to see hospital practices improve. If California and New York can do it, why can't everyone else?

Marissa's Story: Empowerment in Action

“Never doubt that a small group of thoughtful, committed people can change the world. Indeed, it is the only thing that ever has.”  --Margaret Mead

How does change happen?  Sometimes it takes just one person to be the catalyst.  One example is the developing Mother’s Milk Bank of the Western Great Lakes, whose major mover-and-shaker happens to be a mother from my Leche League group.

Her name is Marissa and she began attending my group when her daughter Aria was a baby.  Employed full time as a project leader, Marissa benefited from hearing other employed nursing mothers’ experiences at meetings.  Breastfeeding went smoothly with Aria.  Not so with her second baby. 

At 37 weeks of pregnancy, Marissa’s high blood pressure raised concerns about preeclampsia and led to the decision to induce.  Marissa wrote:

“On May 1st, at 3:23 am, our beautiful baby boy Lennon was born, clocking in at 4 pounds, 5 ounces (1956 g). Within 30 minutes, Lennon was nursing and snuggled skin to skin with mama. After an hour or more, the nurses did a blood test and identified his blood sugar levels as low. They brought me a bottleMarissa & Lennon in the NICU of formula and instructed me to give him the formula to try to boost his blood sugar. A few minutes later he was taken to the NICU for monitoring and treatment.”

The nurse told Marissa that Lennon would be fed formula on a 3- to 4-hour schedule and that she was welcome to feed him the bottle.  When she asked if she could breastfeed him, the nurse told her no, it would take too much energy in his weakened state and the time breastfeeding would take would interfere with the feeding schedule.

Marissa began pumping to encourage more milk flow.  The next day she was told she could breastfeed Lennon after he was bottle or tube-fed formula, but he was usually asleep or disinterested after being given so much formula.

Lennon spent his first 6 days in the NICU until his blood sugar levels stabilized.  During this stressful time, Marissa discovered that some nurses were more open to breastfeeding than others.  Some let her breastfeed before the formula feedings.  Others did not, even banning the lactation consultant from the NICU, when she agreed to help Marissa learn to use an at-breast supplementer to provide formula at the breast.

Marissa learned that at that hospital NICU, whether a baby was critically ill or like Lennon had a milder condition, the staff’s actions and the hospital’s policies actively discouraged breastfeeding. 

After hospital discharge and over time, Marissa began to question her experience.  She wondered why the hospital recommended formula for at-risk babies instead of providing donor human milk, which leads to better health outcomes.  She asked me and others in our local breastfeeding community why we hadMarissa and Lennon now no local milk bank.  

There was no good answer to that question.  Chicago had no milk bank because no one had yet made it happen, so Marissa decided to become its driving force.  With her experience as a project leader, she had the perfect skill set.  Within a few months, she rallied those of us in Chicago who shared the dream and met with a Wisconsin organization that had been a donor milk depot for the Ohio milk bank since 2005.  She successfully pulled us together into a passionate, cohesive group focused on bringing our developing milk bank to fruition.

When faced with a wrong that needs righting, what can one person do?  Many of us underestimate our ability to make a difference.  Marissa’s story is one example of how one person really can change the world.

Where Do Milk Banks Fit In?

During my early years in breastfeeding, I found the idea of milk banks intriguing but less than exciting. To me, the rubber gloves, the lab equipment, and the rest of their high-tech gadgetry were positively off-putting.  All that changed when I attended a conference of the Human Milk Banking Association of North America.  There I finally understood the bigger picture and realized that milk banks play a vital role in a breastfeeding culture. 

To better grasp this role, it helps to know the World Health Organization’s ranking of infant feeding options from healthiest to least healthy.  Healthiest is, of course, direct breastfeeding.  Second is mother’s own expressed milk. Third is donor human milk.  And fourth is infant formula.  

Donor milk can make the difference between life and death, especially among preterm and ill babies.  Although many mothers work hard to try to provide their at-risk babies with their milk, research has found that more than half of mothers expressing milk for preterm babies have inadequate milk production by Week 6.¹ 

This is a problem because very preterm babies are at risk of acquiring a serious condition called necrotizing enterocolitis, NEC for short, and feeding infant formula increases this risk.  When a baby acquires NEC, part of his digestive tract becomes inflamed and dies.   About 1 in 5 babies who acquire NEC die from it.  According to the Centers for Disease Control and Prevention, in the U.S. NEC is the cause of nearly 2% of all infant deaths.  Babies with NEC suffer horribly and the cost of treating it is astronomical.²  Babies whose NEC is severe enough to require surgery are also at risk of long-term growth delays and neurodevelopmental problems, which can affect a family and a society for a lifetime.

This is where milk banks come to the rescue.  Research has found that only 1.5% of babies fed mostly human milk acquire NEC, as compared with 10-17% of babies fed exclusively formula.³  So as the Swedes have already learned, the answer to this terrible scourge is to feed preterm babies only human milk during their hospital stay.  In Sweden, no hospitalized preterm baby receives infant formula before discharge.  If a mother cannot express enough milk for her baby, donor milk is given.

Milk banks provide a safety net for mothers unable to express all the milk their babies need. While direct breastfeeding is best and mother’s own expressed milk is second best, donor milk can be a lifesaver for babies whose only other option is infant formula. 

This ray of hope is why I became a member of the leadership team of the group pictured here, which hales from Illinois and Wisconsin and is working hard to establish the Mothers’ Milk Bank of the Western Great Lakes.  Our plan is to move heaven and earth to begin providing donor milk to babies in our states, where no milk bank currently exists.  An important role of this—and any—milk bank will be to educate hospitals about human milk as the standard of care.  Even with research backing, changing practice always takes time.  But it will be well worth the effort.  Our new website will be premiering soon and I’ll post a link when it’s ready.  Please wish us luck!

References

¹ Hill, P. et al.  Comparison of milk output between mothers of preterm and term infants: The first 6 weeks after birth.  J Hum Lact 2005; 21(1):22-30.

²Bisquera, J. A., Cooper, T. R., & Berseth, C. L.  Impact of necrotizing enterocolitis on length of stay and hospital charges in very low birth weight infants. Pediatrics 2002; 109(3): 423-28.

³Sisk, P. M., et al. Early human milk feeding is associated with a lower risk of necrotizing enterocolitis in very low birth weight infants. J Perinatol 2007; 27(7), 428-33.