First they came for the formula…

Yes Mayor Bloomberg, you can take away the formula from hospitals. You can lecture new mothers every time they request it. You can treat it like methadone, guarding it under lock and key in hospitals or safeguarding it behind the pharmacy counter along with the Oxycontin.

Perhaps it will work. Perhaps you will create an increase in the numbers of women who can and who want to breastfeed, that do. I’ll give you a huge benefit of the doubt here, despite other significant concerns.

But then what?

Then what happens to those mothers?

Guaranteed city-funded daycare at the workplace so mothers can take their infants with them each day? Mandatory pumping breaks at any job? Separate mother/baby lounges adjacent to the restroom in any public building, store or restaurant? Declaration of nursing as a civil right? Stiff fines for individuals caught disparaging or harassing a mother who breastfeeds in a playground or cafe or store or theme park kiddie pool or God forbid an airplane?

Persecution of those who call nursing mothers “disgusting,” “inappropriate,” “exhibitionists” and “perverted?”

If you want more women to breastfeed, it’s not access to formula that’s our biggest problem.


128 thoughts on “First they came for the formula…”

  1. Thank you for this. Formula samples saved my freaking life (and sanity), but maybe if a litany of other things were different, I wouldn’t have needed them in the first place.

  2. My daughter was in the NICU at a hospital that treats a large inner-city population. She was there for so long that we saw just about every kind of attitude about breast milk/formula. There were many moms like me who knew that breast milk could save their babies lives, and did anything and everything to keep pumping. I had that luxury. When I went back to work, my employers allowed me to pump in peace in a private office. My supply was pathetic but I kept at it until I needed surgery for thyroid cancer. Anyway, there was a little baby next to my Daphne with a very young teenage mom, 15 or 16 years old. Our babies had the same nurse. The young mom showed very little interest in nursing. The nurse asked her once if she was sure she didn’t want to try, then quickly brought her the little Similac bottles. After the mom left, I asked the nurse why she hadn’t pressed the issue. She said: “she’s in high school. It’s probably better for the baby to have formula and have mom go back to school.” That really caught me off guard, and knocked me off my high horse.

    1. And that is exactly the reason why we need to stop judging. Choices are just that, CHOICES. Lets keep choices open.

  3. YEAH! What she said. Or better yet, I won’t tell you what to do (or not to do) with your boobs if you won’t tell me what I should do with mine.

  4. @Melissa’s comment, just wow. Knocked me off my high horse too, and I didn’t even breastfeed. Wanted to, but just couldn’t for lots of reasons. Even though I used formula, I did hate that the hospital sent me home loaded down with the stuff. I hate that certain baby stores sold my name to formula companies and they sent me samples. I hate that so many people, Mayor Bloomberg included, feel they can and should tell me what I should be doing to feed my babies.

  5. Massachusetts hospitals voluntarily did the same thing earlier this month, and I was very happy to hear it. I think that preventing hospitals from automatically offering women formula samples in the first days after giving birth is an easy step to take to improve any new mom’s chances at making breastfeeding work.

    Nursing, especially in the early days, is so challenging. The body is exhausted, the baby is hungry, and it’s a recipe for a meltdown. Formula is an easy out, and if the hospital has a room full of samples, it’s far more convenient for a nurse to drop off a couple of bottles than it is to spend 20 minutes with the post-partum mom and try to help her figure it out.

    Sometimes formula is absolutely necessary and no woman should ever be judged for making the decision to supplement or bottle feed. But so often these moms don’t even get to make a decision — it’s made for them before they are equipped to make it for themselves. And once you’ve given a bottle to a newborn, it can be a real uphill battle to get the nursing back on track.

    You’re right — there are absolutely other things that can and should be happening in New York (and Boston and everywhere else) to support breastfeeding mothers. But the things you’ve raised here are not easy. No, the samples are not our biggest problem, but it’s a problem that’s easily solved. I’m thinking it’s OK to start here and then (hopefully) start knocking the other things off your list.

    1. I guess I have trouble with that logic. Taking the so-called easy step, is not quite so easy when you think of where it leaves them.

    2. You saying that it’s the easy out and then saying it’s okay when it’s necessary and those women shouldn’t be judged makes no sense. You can’t hide or ban all the formula and have nurses tell women that they should always breast feed and then expect no judgements to those of us who medically couldn’t. Because hi, that’s me being judged. In fact that was me being judged, three separate times for having absolutely nothing in my breasts. Nine years later they found my medical condition which explains why. But hey, I took the easy way out. Or I chose to feed my babies. Whichever way you’d like to see that.

      Breastfeeding should be encouraged. It should. I fully believe that. I believe it’s a beautiful natural thing. But what happens is that hospitals do this and it tells all of us who need the formula that we are wrong and not okay.

      I have three healthy, happy, amazing kids who were all formula fed. There is nothing wrong with them. Nothing.

    3. What Massachusetts hospitals, are these, I have to ask, because I just gave birth in one and while I wasn’t offered samples, formula most definitely wasn’t under lock and key. I also had a TON of conversations with nurses about this stuff (bored, second kid, etc.)

      The only hospital in the area that is “baby-friendly” in the new definition is MGH.

  6. Dammed if you do, dammed if you don’t. I cannot begin to tell you how glad I was when each of mine hit a year old. Only because then the judgement stopped.

    This isn’t the answer. It just isn’t.

    1. The judgement doesn’t stop, it’s just reversed. My son’s 13 months now and I still breastfeed him. I cannot count all the times people have told me I must be a lousy mother because I haven’t managed to teach my son to “eat like a normal person”.

      1. Oh yeah, I know it goes both ways. I’ve been judged for giving bottles and I’ve also been in stores and at restaurants where my friends were asked to take their nursing baby into the bathroom. Which hi, GROSS! It’s all judgement and it all sucks.

  7. I’m surprised by the reaction to this program. I read the information on the health department website, and I don’t find any of the elements shocking. Many of the items covered are already state law where I live, in CA. Hospitals and supermarkets are required to keep formula locked up. Formula samples may be requested in the hospital, IF a nutritionist or pediatrician has seen the child and declared it medically necessary. (And boy, do they let you know they don’t like it! I had trouble convincing the nurse to even call the nutritionist, despite my daughter’s weight loss, dehydration and jaundice! The nutritionist took one look at her chart and went off for samples. Then she gave us both lessons in finger feeding, to ward off nipple confusion. Why isn’t THAT in the initiative? )

    I also want to point out that this is a voluntary program for the hospitals. They have to choose to participate. Per the NYC Health Dept Website, only 23 hospitals have joined in the first 2.5 months of the program. There are over 50 hospitals in NYC. I’d say, if fewer than half are participating, the initiative isn’t going to go far.

    Beyond the initiative, the other things you mention are mostly already law here, too. Pumping breaks are required of the employer – I am legally entitled to a room with a lock on the door and an outlet, up to 4 times in an 8 hour shift (and they can’t fire me for it), even now that my daughter is 2. Certain facilities are required to have mother/baby rooms (and others just choose to). In any facility (public or private) where I am not trespassing, I am entitled to breastfeed, covered or not, and may not be removed from the facility.

    I’m not sure if it’s because of the law, because we’re in California or maybe I’m just lucky, but I’ve never received a disparaging comment or been called names in the two years I’ve been nursing in public. People don’t even stare. I hear more comments about extended breastfeeding than I do about public nursing, and all of the commenting people are related to me, anyway.

    1. They aren’t required to keep it locked up to make it harder for moms to have access. They lock it up to prevent theft. It’s super expensive and there is a huge black market.

      1. I was going to say the same thing. AND Grocery stores have only the WIC sized cans and brands (12.5 oz I believe) locked up for the most part. The other stuff is usually easily accessible on the shelf, and if you go to a Target in Cali, none of the formula is locked up. Retail establishments are not required by law to do this despite your statement Paige.

      2. Nilzed – the stores lock it up to prevent theft. The hospitals lock it up to prevent nurses from having easy access and to insure that they go through protocol and seek medical approvals and fill out forms, etc, before handing over the formula, as Paige experienced. They have more incentive to encourage breastfeeding knowing that the alternative requires more work on their parts.

  8. I think you make a smart argument, and I’m with you 100% on the “what happens next?” scenario. I’d love it if Bloomberg or anyone else with a podium and a big stick would get behind better, mom- and family-friendly policies.

    But. But. The spirit of what Bloomie wants to do here? I have to agree. I have to. Not treating formula like methadone, no. But banning companies from opening shilling in maternity wards? A zillion times yes. At one of the hospitals where I gave birth (and for the record I nursed both my boys for a year, though I did add in formula after about month 9 because pumping enough at work got too physically taxing for me), there were cases of formula stacked to the ceiling behind the nurse’s station, and one TINY little sign on the desk that said “breast is best.” Nursing moms and potentially-I-might-want-to-try-it nursing moms don’t get much support, not because there aren’t lactation consultants, but because the rest of the staff — nurses, doctors — don’t know THING ONE about nursing. A shockingly low number of health professionals I’ve met as a pregnant person, a new mom, and a mom taking her nursing children to pediatric offices knew ANYTHING about nursing. Taking that overwhelming stack of formula out of the hospitals would help, I’m sure of it.

    I do take Melissa’s point, above, about the young mom. And while it’s true that there are circumstances like those in which formula makes sense (if it’s a choice between that and her finishing high school, duh), why not try to nurse, at least at first? Why not be helped to understand that you have both those options? I took a breastfeeding class before I had my child, and I tell you I was SHOCKED (in a good way!) to learn that it was POSSIBLE to do both! I had no idea! And I knew a lot and had read a lot. You can switch to formula or supplement later, but starting out? Those first days in the hospital? Those make all the difference.

    I really hope this doesn’t turn into a “I couldn’t nurse/don’t judge me/this is nanny state crap” hullabaloo (though I guess it already has — not here, but in general out there). It shouldn’t be. Sometimes some efforts to change policies are in good faith and are at heart good ideas.


  9. I don’t disagree with you – as a society, we need more education/tolerance of breastfeeding moms.

    As a mom who bottlefed (not for lack of trying), this whole thing goes back to moms judging moms. Breast feeding moms tout breast is best (I am sure it is, but I don’t want my face rubbed in it) and bottle feeding moms (not me) use ugly names.

    Removing formula is not going to stop this….because if it is not this – moms will be judging the moms who took their kids to a midnight movie of batman or allowed their kids to CIO.

  10. I wanted to add something. I did a little more digging on the Health Dept’s website. The initiative does cover things alternatives to bottles, like syringe (finger) feeding and spoon feeding. But they cover that because it’s part of the New York State law code. Actually, it looks like most of the program is based on the NY State Breastfeeding laws. They’re just asking the hospitals to voluntarily enforce those laws before acting as free advertising for the formula company. Overall, it’s not a bad thing. And I don’t see anything in the actual initiative that says the nurses are required to lecture the same mom every time she asks for formula.

  11. Thanks for this.

    I worry about the moms who simply CAN’T BF. Many of these moms feel the need to explain to us why they can’t. I know someone who had her breasts burned and damaged in a fire, among other terrible injuries. She shouldn’t have to explain to anyone why she couldn’t nurse her baby, much less get approval for formula.

    As for the supposed nipple confusion possibilities in the early days — hogwash. Some babies develop preferences — others don’t. Sometimes, those preferences shift, no matter what mom tries. But preventing a desperate mom from trying a bottle in those early hours and days after birth is just unnecessarily cruel.

    I’m 100% for breastfeeding — I nursed all 4 of my babies through their first year. But I’ve heard far too many stories from other moms who CAN’T — and shouldn’t have to apologize to anyone about it.

    1. Thank you for this.

      I was heartbroken when I found out I couldn’t breastfeed.
      I wrote about it here:

      And yes, I was hassled for bottlefeeding.
      That doesn’t change my sympathy for those who are hassled for breastfeeding.
      It’d be nice if we could all just feed our babies without getting hassled.

      But– we were really broke when my son was born. Thank goodness for our nurse, who loaded us up with free samples.

      Would Bloomberg’s new regulations stop that sort of gesture?
      That would be a shame.

      1. Thanks for sharing this Roo. Yes, according to the document there will be no more samples, and families that can’t afford formula will be instructed to fill out aid forms for WIC.

        1. I don’t think we would have qualified for WIC.

          What if NYC moms just promised not to serve formula in containers larger than 16 ounces?

    2. Breastfeeding can also be a big trigger for PPA/PPD. No one should really have to explain that to someone who would try to push them otherwise. Full stop.

      1. Thank you for mentioning that. I was depressed after the birth of my son and having a lot of trouble breastfeeding. I ended up exclusively pumping until my milk ran out at 9 months, but it was exhausting and I felt like a huge failure.

        The only assistance I was offered was to “stop by our breastfeeding group on Tuesdays at 11 if you need help.” Well, when you can’t manage a shower for 4 days and can barely function, taking your newborn out of the house is not an easy option. It would be nice if we could get some assistance in the home with this like some other countries offer.

        1. Nope. Glad you’re a survivor (me too!) but no, for some women it’s a major trigger–it was a big issue for me. I don’t mean it as an anti-breastfeeding message, but it can be a trigger. I appreciate your position and what you’re doing (I do! I’m a nursing mom!), but it can be pretty traumatizing for some people. It can. It’s a lot to endure if you’re struggling with new parenthood, depending on your individual issues.

    3. Moms who can’t breastfeed deserve to be cheered on, respected and encouraged. They deserve improved, subsidized access to donor milk (which doesn’t seem to come up in any of these dialogues AT ALL). They deserve compassionate, evidence-based care that is not industry sponsored, on proper bottle preparation and feeding, such as this: . What they don’t need, is a well-meaning but uneducated lay person telling them that nipple confusion or preference is “hogwash”!

    4. God, I hate this discussion SO MUCH. I had every intention of nursing my son, but then he was diagnosed with bad cleft lip and palate, which makes it impossible to nurse. Literally impossible.

      So I pumped for six weeks. That doesn’t sound like a lot, but it nearly killed me. I couldn’t leave the house and all I ever did was pump and feed him. I felt like a cow 24 hours a day – I hated it.

      And then we switched to formula and wow! He started gaining weight, sleeping, and life became more stable. I chose it and it was honestly best for all of us.

      I have a La Leche friend who is very supportive of my choice, but I know some people who aren’t. My attitude is probably too black and white, but you didn’t live through it, I did. And I would do it again in a second.

    5. this. exactly this. thank you, dr. heather.

      my best friend almost lost her first-born daughter because the doctors and nurses at her hospital were so adamant that she HAD to breastfeed and she was a horrible horrible person and would go to hell (yeah, really) if she used formula.

      in the meantime, her production wasn’t enough and her daughter’s throat/swallowing muscles weren’t developed enough and she kept getting thinner. my friend’s mom forcing her to go to another doctor and getting formula and a good talking to finally resolved the issue.

      there is no one right-for-everyone answer.

  12. Nowhere does it say that moms will be “lectured” : No, access to formula is not the biggest problem, but it is one that the mayor could and did act on, and hopefully it will lead to more Breastfeeding Booby Traps being dismantled, one by one, as well as the obstacles that keep moms who can’t breastfeed from having access to donated milk, or non-industry-sponsored information on proper bottle preparation and feeding.

  13. I believe in breastfeeding, and I believe that breast milk is best for the baby – in most cases. But, the breastfeeding debate always seems to ignore a critical component: What about those mothers who can’t breastfeed for any number of reasons. Mastectomy? Chemotherapy? Radiation? How about AIDS? For all the irrational and unfounded concerns we have about spreading AIDS, it’s shocking how people overlook the fact that breastfeeding is one of the few ways you can actually transmit the HIV virus. But those kinds of very real and practical concerns don’t stop the breastmilk brigade from accosting and interrogating mothers bottle feeding their baby on the bus. People should not have had to tell personal medical information to every judgmental passerby who assumed a mother was endangering her baby by bottle feeding her. I did breast feed before the cancer. I breastfed in public all the time.

    NOT ONCE was I accosted for breastfeeding in public.

    I was, however, accosted for bottlefeeding after I stopped breastfeeding for medical reasons. For the record, it’s none of your business what’s in my baby’s bottle. Also, it’s none of your business whether or not I still have nipples.

    1. I have never accosted anyone or seen anyone accost anyone for bottlefeeding but I have had to sit through listening to many a guilt-ridden woman’s about her failure at breastfeeding. It breaks my heart because I can literally not say a thing – the mom will see my breastfeeding and start talking about how she tried to breastfeed but she didn’t make enough milk or her baby preferred formula. It’s not her fault but she is made to feel so, and I will tell you, not by me. By a culture that tells us “breast is best” while telling us to put our breasts away while being ok with scantily clad women in advertising and public while throwing formula samples at us during our pregnancy and laws that don’t give us the kind of maternity leave we need to establish a breastfeeding relationship and supply. I completely empathize with those women but each story makes me angrier that any mom feels she failed in any way and is obviously scarred by it.

      1. When the emergency visit from the lactation consultant resulted in her telling me to give my baby formula right away, I was sure glad I had the hospital samples on hand. As it was we wound up having to bring my dehydrated newborn to the ER that evening, anyway. I dare say that any new mom who has to return her infant to the hospital just days after being discharged feels a horrible sense of guilt and failure. Or maybe that was just me….

        I think Bloomberg’s stance is a bit harsh.

  14. I don’t think it’s a bad idea to keep the formula samples off the nightstands in the maternity ward. I DO think it’s a bad idea to make anyone feel guilty or bad or ANYTHING for requesting it. I think it’s a bad idea to give mothers a lecture EVERY SINGLE TIME they request formula. And the “medically necessary” clause? When does that kick in? Many mothers’ milk doesn’t come in until well after they kick you out at the 48-hour mark. Then what?

    If the government is going to bully or guilt mothers into at least attempting breastfeeding, then the hospitals are going to need more lactation consultants to help with all that “education.” That’s a whole other level of training for nurses, which is a whole lot of money. Who is going to pay for that?

  15. Thank God big brother Bloomberg is in charge so women don’t have to make any choices with their bodies or decide for themselves what is right for their babies.

    We all know that only the government is capable of handling any big decision. We should all praise Bloomberg for relieving us of that great burden of “Freedom”.

  16. Liz, I love you to pieces but you are dead wrong. It IS access to formula that’s our biggest problem with breastfeeding, or one of them. And it goes deep.

    I am not talking about the individuals who have no interest in breastfeeding or the minute percentage (I believe the estimate is 5%) who physically cannot breastfeed. Most moms end up quitting breastfeeding because formula is introduced at a period where establishing milk supply is tantamount – the first 24 and 48 hours after birth. One supplementation can literally tip the scale and make establishing a good supply extremely difficult. The more you nurse, the more milk you make. If you supplement every other feeding, you are telling your body that you don’t need that much milk. And it’s a slippery slope that leads to a mom –needing- to use formula. And this is something most moms don’t know. Our bodies are not like a store where you can just grab a gallon a milk whenever.

    Formula companies are in bed with hospitals and practice extremely predatory marketing. Gifts, contests, free lunches, etc., similar to the perks bestowed on doctors (which are owned by pharmaceutical companies who we know love to dole out swag). I’ve also heard that formula companies are instrumental in designing maternity wards.

    And you have to understand that hospitals do not buy their formula. It is provided by the formula companies to the hospitals but who do you think actually pays for it?

    Similar to the formula “gift bags” every mom is sent home from the hospital with (even the moms who are breastfeeding receive a breastfeeding “support kit” which coincidentally includes formula!), rampant and free access to formula actually hinders breastfeeding because it sets moms up with the expectation that it’s ok to fail at breastfeeding, that breastfeeding is so hard that we’re going to send you home with formula.

    All of these freebies means that every parent who shells out upwards of $20 per canister of a product that costs several dollars to produce – it is all figured into the price just like “breakage” is figured into retail cost of products. So for every case of free formula or catered lunch for nurses on the maternity ward, moms who pay for their formula are paying the inflated cost.

    I know many moms appreciate the free “just-in-case” can in the pantry that can be pulled out during a nursing strike or when mom is exhausted and needs a break. Having formula in the house makes it a lot easier to supplement but every bottle of formula given to a baby and not removed from the breast depletes a new mom’s supply because demand is what drives supply. The more you nurse, the more milk you make.

    As for the case that many moms welcome the free formula because it’s so expensive, well, what happens when she leaves the hospital and the free formula is used up? She’s gotta go pay $20+ per can and her milk supply is now gone and she HAS to formula feed. Even families who receive WIC are screwed because they only cover about 80% of an infant’s formula needs. And so those moms have to scrape together money to pay full retail and sadly, some water it down if they can’t afford this.

    How do we increase breastfeeding rates? By supporting moms with education and inspiration during their pregnancy and throughout their child’s life. By understanding that breastfeeding is “natural” but it doesn’t come easy to everyone. Especially when our mothers and mothers-in-law generally can’t help us figure out the mechanics of it because they probably didn’t breastfeed us or our partners. Especially when everywhere you look, a bottle is used to represent babies and we grow up thinking that’s how babies are fed and that our breasts are for our lovers.

    I’ll close with some simple stats. In 2011, according to the CDC, nearly 75% of babies received breastmilk before leaving the hospital but only 35% of babies are exclusively breastfed by 3 months of age. You can certainly explain our paltry FMLA/maternity benefits on that but formula is also hugely responsible for this. (24.5% of breastfed babies received formula by the time they’re 2 days old.)

    Read this great post by Best for Babes on the hospital marketing plans of formula companies.

    1. I know this is a passionate cause for you, Danielle. Thanks for your perspective.

      But I’m not sure how I’m “dead wrong” when my point seems to match the conclusion of your stats: We don’t live in a culture that supports breastfeeding.

      1. While your conclusion that our culture does not support breastfeeding is correct, your criticism of this important step without understanding it fully actually makes it harder to achieve this conclusion! You have a powerful voice, Liz, and your followers and readers deserve to know the facts as I outlined in my response to Katherine Stone:
        “As a severe PPD survivor I deeply appreciate your commitment to protecting the women you serve. Best for Babes is proud to support your efforts, so please consider:
        1. Nowhere in the protocol for the initiative does it say that health professionals must “continually remind the mother why she could be making a better decision” or that they must “browbeat her” or give her a “stiff talking to”. That is your interpretation, it is not fact, and it does a grave disservice to the legions of health care professionals who are trained to support and encourage. It detracts from the need to hire more highly-qualified IBCLCs who can accurately diagnose PPD, tongue-tie, IGT or other conditions, and give moms the evidence-based care, cheering on, and nurturing they deserve.
        2. Breastfeeding lowers the risk of post-partum depression through the release of powerful mood-boosting hormones, improved bonding, and the life-long empowerment that comes from doing and succeeding at something challenging. Why does your post omit this information? Moms at risk for PPD who make an informed decision to breastfeed deserve to be protected in the hospital from practices which undermine breastfeeding (see #5).
        3. Unfortunately, a great many more medications are compatible with breastfeeding than physicians and pharmacists realize, because they are not required to refer to the best, most comprehensive database, Dr. Thomas Hale’s “Medications and Mother’s Milk”, also found at
        4. By controlling infant formula, hospitals will be under greater pressure to provide the far superior alternative: screened, pasteurized donor milk which is safer than donated blood. Again, a tiny percentage of mothers won’t be able to use it due to their religion or because of galactosemia; but especially for preemies, donor milk is a proven life-saver, and most hospitals do not make it available.
        5. By mis-characterizing Bloomberg’s effort, you are doing a disservice to the 75% of mothers who have chosen to breastfeed, but are having their choice restricted by the influence of formula marketing, including unnecessary supplementation without the parent’s consent, bullying into formula feeding (“you have to give the baby a bottle before you can leave the hospital”, “you are starving your baby”, “your breasts are no good” etc.) and being pressured to take free formula gifts so nurses can meet their formula contest quotas (yes, it’s true: they play “save the bottle caps”). While there is no doubt that BOTH formula-feeding and breast-feeding mothers are being bullied in the hospital, it is not right to defend the 25% former and not the 75% latter.
        6. This is just one step in removing the barriers that breastfeeding mothers experience in exercising their feeding choice, by supporting this step, we can ask for more steps, such as full baby-friendly compliance in hospitals, increased access to donor milk, and improved evidence-based care for moms with PPD and moms that can’t breastfeed, including independent, evidence-based information on proper bottle preparation and feeding.”

        1. Thank you Bettina, I know you’re well-informed as a strong breastfeeding activist. But don’t assume that I have come to my conclusions based on misunderstandings; we just have different perspectives.

          Also, if you read my post, you’ll see it’s not a condemnation of the policy with a thorough discussion of pros and cons. It’s a simple point I’m making about a culture that doesn’t support breastfeeding, and in making a simple point, obviously I omit a crapload of information. (Which is why I’m happy for the conversation in comments, which brings to light many, many other aspects of the issue.)

          If the NYT Magazine wants to hire me to do a thorough 20,000 word objective analysis for the cover story, I’d happily oblige.

          I happily concede that you bring up a lot of good points. However it is pretty clear to me that there’s a difference between encouraging breastfeeding…and discouraging formula feeding. The latter is what I get from all the official documents I’ve read. I don’t believe I’m mischaracterizing anything – I have not used the terms browbeating or “a stiff talking to.” The words “If she still insists…” indicates a level of persistence that makes me uncomfortable.

          I certainly would never advocate a nurse “bullying into formula feeding” and as I’ve said above, we need better trained nurses in general to support all mothers. Not just the 75% and not just the 25%.

      2. Yes, this is a passionate cause for me. It’s also one that I have been trained in (I have 50 hours of education under my belt) so I am extremely familiar with the background and physiology and culture on this.

        It’s true that we don’t live in a culture where breastfeeding is not properly supported but why do you think that is? The rampant marketing of infant formula is to blame. Can you think of any other industry where the first taste is free? Like drug dealers (and I am by NO MEANS comparing formula to illicit drugs, merely the sales practice), formula companies give you a taste for free and then when you’re hooked, they hit you with the shockingly high sticker price.

        This stat from the Times article about the initiative is telling- limitation to free formula in hospital maternity centers DOES increase breastfeeding.
        “NYU Langone Medical Center, which has already restricted access to formula, has seen its breast-feeding rate increase from 39% to 68% by doing so.”

        Here’s another interesting stat:
        “An August [2011]report from the Centers for Disease Control and Prevention (CDC) found that close to 80% of hospitals give infants formula when it is not medically necessary.”

        And a number of studies show that formula “gift bags” DO decrease the length of exclusive breastfeeding.
        Here’s a list of some of them:

        To quote Ban the Bags, an organization the promotes prohibiting the formula “swag” handed out to mothers after birth:
        “Formula reps have unparalleled access to maternity staff in hospitals. Reps are vendors. They should not be treated as part of the
        healthcare team. They have succeeded in getting hospital staff to market for them. Hospital staff and health care providers should not be acting as formula marketers, nor should they lend their prestige to a product that undermines the health of our nation’s infants and mothers.”

        It’s short-sighted by Bloomberg and the medical establishment to think that providing breastfeeding info immediately postpartum will make the greatest difference but in our culture, it’s at least ONE step. It should not be the only one, though. Nurses need to be re-educated about breastfeeding. Any doctor who deals with infants and young children and pregnant women should be educated MORE so that they can give accurate breastfeeding advice (in my opinion, pediatricians should all be required to become board certified – IBCLC is the certification) – in reality, most receive just a few hours about breastfeeding in their med school training. And OF COURSE women should receive at least 3 months paid maternity leave – coincidentally, just about the amount of time it takes to establish a healthy milk supply.

        I don’t want hospital staff to bully patients – and I am not reading the same persistence in the literature – but in order to gain momentum for breastfeeding, a mother -does- need to be educated about the risks of choosing formula over breastfeeding. This should be done by her obstetrician or midwife and prior to birth. It’s pretty late to try to convince a woman with a crying hungry newborn that she should give breastfeeding one more shot. It’s like throwing a kid in a car before they take driver’s ed. Sure, they might not crash the car but if you don’t know the difference between the brake and the gas pedal, or how to shift gears, it’s definitely going to be a very bumpy ride. But getting hospitals to take responsibility for their formula usage means they might actually throw some weight into their lactation education which is a very positive benefit for all moms and babies. Instead of tossing a bottle at a mom who is exhausted, they can support mothers by working with her to get a good latch and maintain mother-child contact which increases frequency of nursing which increases supply.

    2. You are dead on! Thank you for stating the truth about this issue, even if it seems nobody really listened. Appropriate BF education should be a part of all medical training, drs and nurses. People do not realize that their OB or often their pediatrician was required to take less than 6 hours of instruction on BF in med school. Their nurse less. This is where the change needs to happen. And yes, no woman should be judged for her choices. But they should be appropriately educated so THEY can make those choices, not the hospital staff or their mother in law or the formula companies. And yes somebody pays for all those free samples.

      Me, I had a breast reduction when I was younger. I was lucky, my boobs worked great! I nursed painfully and miserably for three weeks before my sad little supply due to lack of breast material became an issue. Then we did boob then bottle until my man was 4 1/2 months. The wee bugger refused the boob after that much to my sadness. But if I had not at least tried to establish my supply in those early days and weeks I never would have had the chance to have my darling on my boob at all.

      Thank you for what you said.

      1. Wendy, its not that “nobody listened” – her comment was flagged as spam and I just approved it (midnight) so there simply aren’t responses to it yet. I’m sure they’ll come. But disagreement doesn’t necessarily mean not listening either. Just a thought.

  17. I was lucky I got to BF, but I know some people who aren’t that lucky. I know someone whose baby had a tongue tie and she herself had inverted nipples and baby could not latch, and this was not discovered until the baby was already 3 weeks old by a lac consultant. She tried for 5 weeks, and if she got her daughter to latch it would take her minimum 45 minutes. She finally gave up because her daughter was not gaining weight.
    They can’t assume a mom who used formula didn’t try to nurse, and in the grand scheme of things, isn’t the most important thing a baby that isn’t starving?
    I know the argument is that formula companies try to market market market, then if that’s the case, lets leave all the freebies locked up when leaving the hospital, diapers and all!

  18. The issue needs to be reframed. It is not about the mother’s right to nurse if and when and where. It’s about a helpless infant’s right to eat. A baby has the right to be fed promptly and via whatever method it’s parents have chosen for it. The infant should not denied food until a nursing mother can find a hidden spot to protect the world from a brief sight of boobs at work. A baby should not be expected to eat in a place that no one else would eat: when was the last time you ate lunch in a toilet stall

  19. Sigh – my daughter was adopted at birth & was a preemie – & only
    had formula (healthiest kid ever) my son only nursed, hated formula (caught everything & had chronic ear infections) but even in San Francisco I got flak for both bottles & nursing!! Especially the six months while the toddler still had her bottle while her brother nursed… There are way too many people who feel they can complain about your choices. It was really frustrating that so many people took the time to criticize?! Hospital policies like this will make it worse.

  20. I was one of the ones who was determined to breastfeed, and I’m all for it. I don’t want to still be nursing my kid when she can lift up my shirt and say, “Mother, may I?'” but that’s me. I’ll tell you what, though, those samples I got in the mail and from the hospital are super convenient when I want to run out and leave the baby with Grandma. We use them now.

    This logic IS flawed, on so many levels. Some women can’t/won’t/don’t breastfeed for whatever reason – and that is their business. Denying them freebies in the hospital won’t change anything. It just means people will have to pay for it. And that will be money in the formula company’s pockets.

  21. In Canada women can take 12mos off for maternity leave.
    Their jobs are still there waiting at the end. Due to financial reasons,
    most take 9mos off since you usually get paid most of your salary
    in that first 9mos. Needless to say this time off helps breastfeeding. We have a higher percentage breastfeeding than the US.

    I should add that I breastfeed but do not see formula as poison as
    some do.

  22. I love this comment thread, the diversity of opinions, and the total respect for one another’s varied experiences and perspectives.

    Wherever you come out on this…you guys are awesome.

    1. I was just thinking that as I’ve gone through the comment thread.

      I don’t have a problem with this initiative, but that comes from negative personal experience with the nurses giving my son formula against my wishes (and then finding my hard-won 3 oz in the NICU fridge two days later). I see it as the pendulum swinging back.

      But then I also don’t have a problem with the limiting to 16 oz. of the sugary drinks. I think I may have been THE Nanny State in a past life.

  23. YES! I love this. As a mom who breastfed both her baby (still breastfeeding a 17m/o) I NEEDED those samples. More accurately, my babies NEEDED those samples. My girls both had some formula in the early days and *shock* the world and my supply didn’t come crashing down. Most importantly, as a mom who supports breastfeeding, I also support a moms decision to choose what is best for their family.

  24. I never really gave the free formula and the bags any thought, only bummed that as someone who had decided to BF that there wasn’t really anything in there for me. What can I say, I like swag!

    But it took a few kids and talking to a lot of moms for me to understand what a complex issue this is — and while I do think it needs attention, I think (as I said in the HLN News Now segment) this is a super lazy approach. And also very 1950. One case where retro is not cool.`

    My feeling is that having access to the formula, whether it’s on the nightstand or in the chair in the room is not somehow going to encourage moms to use it. That’s actually pretty insulting to moms.

    1. The stats in the report indicate that when the formula isn’t readily available and the staff is trained to support breastfeeders, that the breastfeeding rate increases 23%. I think that’s great, particularly if it’s women who want to and intend to breastfeed. However it’s the combination of the two that is effective.

      That said, I can’t help but think of people who believe that access to condoms leads to promiscuity. Am I totally off-base?

      1. I actually led off with the condom comment on the show.

        And I think those stats are valid. It is the combo of the two and it’s also how it’s presented. They can’t monitor how each nurse is talking to each mother. It’s such a personal, complicated issue, the idea of mandating something makes me uncomfortable.

  25. Someone who supports this initiative told me today that I was mistaken. She said that nurses would not be “lecturing” mothers, and sent me the actual wording from the either the Health Dept. or one of the participating hospitals (wasn’t sure which):

    While in the hospital your staff can:
    • Assess if breastfeeding is going well and encourage the mother to keep trying.
    • Provide education and support to mothers who are experiencing difficulties.
    • If the mother still insists on receiving formula, document it in the chart along with the reason and distribute only the amount of formula needed for the feeding.

    How they worded this tells me a lot. If the mother “STILL INSISTS?” She has to insist, and if she insists they’ll give it to her? I just don’t get it. I’m all for more promotion of breastfeeding and for less marketing of formula, but I guess I’m gonna have to STILL INSIST that this goes too far.

    1. I read that as well Katherine, and that language also jumped out at me as disturbing. I do love the idea though of more hospital staff being trained and encouraged to support mothers trying to breastfeed. Clearly that’s a major problem in the hospital system right now, from a lot of reports I’m seeing. But I’d hope that nurses are trained to support all mothers equally.

      1. I’ve been arguing this point all day on Twitter. The language in this document is REALLY disturbing. Of course they don’t come out and say “yep, we’re going to browbeat women for making the wrong choice.” That would get the women’s rights organizations all up in arms.

        But I would hope that the women’s rights organizations have been around long enough to know that when it comes to how women and their bodily autonomy are treated in society, it’s vital that we read between the lines.

      2. But this is specifically for mothers who state they want to (and are) breastfeeding, not moms who state they want to formula feed from the start. The point is that if you are breastfeeding and think your baby isn’t getting enough or are otherwise not feeling 100% confident about how things are going, you may want your baby to get formula when it really isn’t necessary. Hence, the education piece. The nurse (or preferably, IBCLC) should be then brought in to assess what is going on and decide if formula really is the best course of action. If it’s not, then yes, the mother needs to insist on receiving it. Maybe the language isn’t the best, but I don’t have a problem with a mother whose baby doesn’t really need formula needing to have someone discuss this with her. The fact is, most people don’t understand a lot of normal newborn behavior, because they are new parents and because we have been a formula feeding culture for so long. I think a lot of the initiative isn’t being understood by lay people who don’t work in the hospital, which is why I loved this post by Rebecca at PhDoula:

        1. thanks Elita. As I said in my post, I hope it encourages more moms who want to be able to breastfeed to do just that.

  26. Just wanted to mention that the health reform law includes protection for breastfeeding. It included a provision to amend the Fair Labor Standards Act to require employers with 50+ employees to provide a non bathroom space to pump for up to 1 year. Breaks for pumping are allowed too. Employers with fewer than 50 workers can opt out if they can show undue hardship. Not perfect but a start.

  27. Oh my. I think back to my first days as a new mother and I was an emotional, exhausted wreck. I was one of the ones who was determined to breast feed, was constantly told by nurse staff/friends/family that it is hard to tell if the baby is getting enough in those first few days, but keep at it… only to learn that I wasn’t producing enough. I was sad and felt compelled to explain my story to other breastfeeding moms when given THE LOOK.

    In my circle of friends and acquaintances, I think many Moms have a pretty solid idea as to whether they are going to breastfeed or formula feed before they even have their babies. I don’t think it’s fair to treat emotionally overwhelmed new mothers as if they are doing something shameful or illegal if they need/want to formula feed.

  28. Brilliant points. Absolutely brilliant. Frankly, I’ve been so crazed over this keeping-formula-locked-up-and-lecturing-moms-each-time-they-ask-for-it nonsense, that I haven’t even touched on the larger issue in any of my online discussions about this initiative. And you’ve pointed it out, perfectly: we can encourage new moms to breastfeed at the hospital. That’s great. But considering our breastfeeding rates PLUMMET after the first 3 months, I highly doubt it’s the ability to “score” formula from the drug pushers – erm, nurses – that is making it damn near impossible for women to achieve the AAP recommendations.

    My concern is mostly for the moms who enter the hospital fully intending to breastfeed (as many of us do) and find that nature or life had other plans. Sometimes a baby’s latch just sucks (literally) and a relief bottle can save breastfeeding. Other times a woman may be struck by disturbing emotions surrounding nursing, from PPD, D-MER, or past sexual trauma. And in these cases, the women are already in a fragile state – disappointed in themselves, upset about their breastfeeding dreams turning into nightmares. Now we will need to pour salt in their wounds. Lovely.

    1. I really am happy to see Liz, Katherine and FearlessFormulaFeeder standing up for moms here. I know that breastfeeding problems made my PPD after having my first child so much worse. All of the “breast is best” messages made me feel like a complete failure, and I resisted getting the help I needed to recover because I worried other mothers would judge me for bottlefeeding. With my second pregnancy, I had severe antenatal depression. Despite the recommendations of my ObGyn and a psychiatrist specializing in PPD that I focus on my health after delivery, I was committed to breastfeeding because I had internalized “breast is best” messaging. It took weeks of worrying about it and discussing with friends, family and professionals for me to make the decision to do what was best for my health (taking medicine that would have been unsafe for breastfeeding and asking my husband to handle the night feedings, etc). I am thankful that the nurses in the hospital did not pressure me after I told them I was formula-feeding. In my fragile state, it would have been devastating. And I would not have welcomed having my mental health documented on some “formula log” due to some government regulation as if I were receiving methadone or some drug. What exactly do they do with their formula log? Do people study the reasons women ask for formula? Who has access to that information? I value my privacy, and I know that women with PPD have been harassed and intimidated by social workers in some states. Would their privacy be protected?

      1. Thanks for sharing this Deb and asking such good questions. It’s really helpful to hear all sides, all from such personal places.

    2. Only 5% of women cannot physically breastfeed. I don’t know how many are unwilling or unable to because of emotional trauma. But the reason a majority of women who do not meet their breastfeeding goals is because they are not adequately supported. Decreasing access to formula needs to be complemented by increased access to support immediately after birth. Paying lip service to breast is best is only going to make a mom feel guilty. The medical community has to step it up and truly support breastfeeding by providing the resources and not letting aggressive marketing stand in the way.

  29. Like @Celeste, I’m an adoptive parent – and maybe a formula policy like this wouldn’t have affected me or even my son, really. But it saddens me to think that a mom who is placing her infant for adoption might be forced to “still insist” on this additional choice for her newborn. I realize this is a small subpopulation, but I can’t help but think of my son’s mom jumping through this additional hoop during such a challenging time, when so many of her choices were already under intense scrutiny.

  30. I support breastfeeding, but I also support a woman’s right to choose. If it is my body, it is my right to decide what I do or do not do with my breasts. Male politicians just cannot resist attempts to legislate women’s behavior, and the “Latch On” initiative crossed the line from educational to coercive in my opinion.

    With my second pregnancy, I made a choice after speaking with my doctor to use formula in order to recover from some complications. I had a toddler at home who needed me and felt my health was more important than breastfeeding. I was educated about the benefits of breastfeeding, and I made an educated decision. That was my right. If I had been repeatedly harassed in the hospital every single time I requested formula, I would have felt bullied and angry.

    No mother should have “to insist” on using formula. I have breasts, but that doesn’t mean that the government can tell me how to use them. I particularly find it insulting when pro-choice politicians try to push legislation like this. They support women’s choice only when women are organized as a political lobby to defend our rights. Their tendency to legislate women’s behavior sneaks out when there is no organized opposition to defend those rights. It’s politically easy to make these statements and to blame/shame the mother for not breastfeeding instead of addressing difficult issues such as maternity leave and employment policies.

    1. Exactly. Perfectly stated, Debbie.

      The aggressive marketing tactics of formula companies notwithstanding, breastfeeding is not properly supported throughout all levels of American society. Education on breastfeeding, LONG BEFORE a woman even gets pregnant, is paramount to changing the perception on all those levels of society.

      The de-sexualization of breasts. Let’s maybe start there.

  31. I’m confused. I thought the idea was to take the formula off the nightstand and have it available if requested?

    If so, I’m pretty sure that is what the hospital I gave birth at did. I have no idea if that is mandated by law out here in crunchy California, or if that was just the policy at the hospital. There was no formula visible anywhere in my room. They did, however, bring me formula and showed me how to supplement with it without destroying my supply when my first baby had a hard time establishing a latch. I got great help from a wonderful lactation consultant. Then they followed up with an awesome breastfeeding support group that helped me through the rough first months. They also had a general post-partum support group on a different day, so I don’t think (but can’t swear) that formula feeding mothers were just left out to dry.

    So really, I’m not sure what the problem is with taking formula off the nightstand. Maybe they could replace it with a short article on the judgment onslaught that new moms can expect, and how to withstand it. THAT would have been very helpful. I had no idea what was coming or how to handle it. Wear your baby all day! You’re not doing enough tummy time! Let your baby cry it out! Just sleep when your baby sleeps! What, are you still nursing on demand at 6 months? You’ll spoil the baby! You don’t have sunscreen on your baby? OMG! You DO have sunscreen on such a little baby? But what about the chemicals? OMG! Why aren’t you dressing her in more pink? Don’t put her in a dress! How will she learn to crawl? You’re going back to work ALREADY? And leaving her at a DAY CARE CENTER? OMG! Don’t you know those places are germ fests? You’re doing sign language with her? Aren’t you worried it will make her not want to learn to speak as soon? Don’t let her eat off your plate! She’ll choke! She didn’t eat off your plate? Well, that’s why she’s a picky eater.

    (These, by the way, are all actual comments I received during my first year of motherhood.)

    Seriously, it all comes down to how this is implemented. Nurses who are going to judge you for feeding your kid formula are going to do it whether you have to ask them for the formula or not. The important thing is- if they express that judgment, do they risk reprimand? If you ask for formula, will they bring it without argument? I suspect one of my nurses thought poorly of me for not feeding my first baby more formula when we were struggling to get the latch to work. You’re judged no matter what you do.

    I did somehow end up with free formula samples after both births. I ended up donating them to the food bank.

    1. My hospital also did not offer formula and had a good LC, and is one of the signers of the agreement. I have no issues with that. I love the idea of mandating better training for nurses and limiting marketing in the hospital. My issue is one of access. With language like the mother having to “still insist” on breastfeeding, that sounds an awful lot like a mandate. I also worry about things shifting the other way — right now the issue seems to be nurses who offer formula because it may be easier for them. After this, will those same nurses refuse formula because it’s easier for them? After all, if you “insist” on it, they need to provide more information, then get access to formula through a supervisor, then fill out charts and file reports. Not everyone is lucky to have the nurses I had. So I can understand the concerns of some of the women here.

      1. After catching up on this in my blog reader last night, I tweeted that it seemed like the problem isn’t that NYC wants to take the formula out of hospital rooms. It is that they are bringing judgment in. I still think that is true.

        Given that, rather than digging into our respective corners about breastfeeding vs. formula feeding, maybe we should work together to come up with wording for the rule that would accomplish the breastfeeding advocates’ goals of removing formula from the bedside table and ensuring a mother knows the risk to her supply of supplementing w/formula in the early days (useful public health goals, supported by research) while also ensuring that women who want or need to formula feed have access to formula and are not subjected to cruel and counter-productive judgment (just plain mean).

        Something along the lines of…”Formula will not be displayed in the new mother’s hospital room, but will be available upon request. If it is requested, the mother will be told once about the risk to her milk supply and future breastfeeding success caused by early supplementation, and will be offered advice about supplementation techniques that minimize these risks. After this single counseling session, if she chooses to formula feed she will be provided with advice about how best to formula feed a baby.”

        1. You need to work for the city council, Cloud. Awesome.

          I’d love a line in there along with “we need to support nursing mother” about how we need to support all mothers, whatever their choices, making sure they’re informed and provided for. Isn’t that really the gist.

  32. Okay New York, this California girl will be impressed when you guys bring back wet nursing. I’d love to see the comment boards for that one. Till then, boob…. formula…. both have resulted in perfectly happy and healthy babies.

  33. I am English, in the UK we have this, formula bring strongly discouraged, we also have 9 months paid maternity leave and entitlement to an additional three months unpaid, legislation which affords nursing mothers pumping breaks, or a room to nurse if your child is brought to you, civil remedies in England and Wales, and criminal remedies in Scotland if you are harassed or asked to leave a public place whilst nursing, and an increasing emphasis on the need for support for breast feeding mothers in the NHS. We have one of the lowest breast feeding rates in Europe because advice is confused and the culture hasn’t shifted. I have heard breast feeding expert health visitors employed by the NHS give advice that if followed would sabotage a breast feeding relationship.

    Australia has an amazi g breast feeding rate because it did all of the above and had/has a major public health campaign with good adverts and superb support for women. You can’t change a culture without a cultural shift.

  34. Wow. What’s next – our do-nothing Congress ramming through a bill making formula feeding illegal? I am stunned by this. I support breast feeding, but I’m really concerned by the “my way or the highway” tone those conversations have been taking. FWIW, we had our son via surrogacy and while our surrogate provided breast milk for a few months, when she no longer could, we switched to formula and honestly, we did it without a second thought. I could have attempted to induce lactation but decided against it. Who knows, maybe I’m judged as a lesser mother because of it, but I’m happy to defend myself to anyone.

    Yeah, removing formula samples is easy. The cultural shift necessary to make a supportive breast feeding culture is the hard part.

  35. Breastfeeding is great, but, as pointed out, not everyone can do it. I find the militant breastfeeders, as I call them, far more dangerous than having formula available if women need it. Anecdotally, I have two children. The one I breastfed had endless ear infections until he was about three, and suffered from schizo-affective disorder. The one I formula fed has never had a single ear infection, and graduated at the top of her high school class. Neither one suffered from any horrifying or dangerous illnesses in their childhood. Go figure. I know that’s just anecdotal and doesn’t jibe with the accepted research, but it’s interesting to me.

    If you want to breastfeed and can, do it. If you don’t, don’t feel guilty about it. I don’t need or want the breast police making women feel inadequate for doing what works best for them. In the grand scheme of things, breastmilk might help your kid or it might not do a damn thing. There will be far more important things in the way you raise and feed your child than whether you breastfed or not.

    And Bloomberg needs to just shut up and go away. He’s an ass.

    1. I find it slightly ironic that breastfeeding advocates are always claiming discrimination and unfairness (hey, I know it happens and it shouldn’t – totally with you there!), but when a woman says “I honestly couldn’t,” they’re quick to say, “well, you really can.” Statistics mean jack when you’re the one affected. It didn’t work and I damned tried.

      I’ll never forget the lactation consultant who knew my son had cleft, marched in my hospital room, and grabbed my boob without so much as an introduction. I was too exhausted and emotional to say anything, but it pissed me off. Boundaries, people. This is a boundaries issue.

      Who’s the one being discriminated against here?

  36. You raise perfect questions about breastfeeding and the workplace. Almost every mom I know who works outside the home mentions “dreading” going back to work and putting their infant in daycare at some point. Many have horror stories of pumping in utility closets/break rooms/conference rooms with blinds closed/restrooms. I had a (female) boss ask a few times if I was done yet through the bathroom door. Few of these mamas wanted to stop working and stay at home permanently, they just needed a little more time, a few more months…and I love Jen Singer’s comment – so Big Gulps and baby formula are out, but I read today that Chik-fil-A is welcome?!

  37. After reading the many and varied responses, I felt compelled to throw in another 2 cents. What kept running through my head as I read was “my kid, MY choice! When I delivered my first 6 years ago, I was asked right away what my feeding choice was and was given amazing support as I learned to breastfeed for the first time. And when I walked out of the hospital, yes, I was still given samples. I made the choice to both breast and formula feed and was perfectly successful at both. And I did so guilt free. However, I have friends who made an INFORMED choice not to breastfeed. Not for personal medical reasons or because their babies couldn’t successfully nurse. One friend in particular just never felt comfortable doing it, even with the assistance of lactation specialists. I think it’s demeaning to force Moms to beg for samples and then have to further justify their choice. It feels like a guilt tactic to me. Can we stop making Moms feel guilty about their feeding choices?

  38. Absolutely! It’s our breasts that are the biggest challenge! And I get judged for that every day.

  39. my head is swimming with so many different thoughts right now–there are such a huge # of valid and informative points of view on this subject! i had an interesting experience in the hospital with my first, when the nurses noticed that he was jaundiced and not pooping. my supply hadn’t come in yet, and it was suggested that we supplement him with formula. i politely requested that we see if i could instead pump some of my own supply to give him, and was readily given what i needed to do so. it was a bit of an uphill battle that first week or so, but we successfully navigated the challenge without any formula…which, by the way, resulted in a huge oversupply for me (hello painful engorged breasts) thanks to my pumping so early. BUT, i fully recognize that my story is not everyone’s. i consider myself lucky on multiple counts: 1. my body responded as it did; 2. my son’s body responded well; 3. the support i was given by the hospital staff, my pediatrician, and my husband.

    i have a lot of trouble understanding why so much of our culture is still so unsupportive of breastfeeding (despite the ‘breast is best’ campaigning–talk about hypocrisy!), but i also despise how judgmental and cruel people can be towards those who bottlefeed. sure, i’d love to see higher rates of successful breastfeeding, but i also understand that the reason behind the stranger next to me in the mall giving her infant a bottle is 100% none of my business, and also doesn’t mean that she’s in any way a bad mother.

    i guess i have a foot on both sides of this argument. i agree that we need to take steps to better support breastfeeding, and maybe re-examining and better monitoring access to formula is one of those steps. but i’m not sure that i agree with how difficult and ‘judge-y’ this particular mandate appears to be. babies need to be fed, and mothers should feel supported and cared for during those already difficult early days of motherhood.

  40. As a woman and a mother, I am very concerned that government officials feel that they have the authority to tell mother’s what is best for them. I am an avid supporter of breastfeeding, I have breastfed all 5 of my children, and I’m currently nursing my 21 month old daughter. I believe that breast is best, and I have seen the results through my own eyes, with my own children. However, this decision is so personal, and every mother should be able to make the decision for herself. Not all mother’s are as fortunate as I, in that I do work from home, so I can feed my daughter on demand and still have a full time job. Not all mother’s have the support of their families and spouses, or access to the necessary resources, such as lactation consultants or the internet. Through my breastfeeding journey, I have dealt with many pediatricians, whom were not educated enough on breastfeeding, to offer me advice or support regarding common breast feeding problems. If we want more mother’s to breastfeed, local governments need to set up resources within the community so that, 1) the act of breastfeeding becomes more mainstream an normal to society & 2) so that the health professionals who help a mother and child through pregnancy and after birth (OBGyn’s, Pediatrician’s), can continue to support mom’s as breastfeeding issues and questions arise. Lastly, regardless of how great breast feeding is, those who have done it know that it requires a lot of time, and dedication on mom’s part. Some mom’s are just not able to put in the time required to build a successful breastfeeding relationship. I will not judge those mother’s or ask why, as it is none of anyone’s business. As a woman and mom, I support breastfeeding but support a mother’s right to choose what is best for her family just as much!

  41. Sometimes I just can’t believe we’re still rehashing this. Putting each other on the defensive when we’re damn lucky we’ve got choices that are all safe and healthy.

    Aside from that, I also can’t believe there’s so little discussion concerning the crucial points Liz mentioned regarding post-hospital breastfeeding support. The obstacles that breastfeeding mothers face don’t end when we leave the hospital; they’re just beginning. The policy makers don’t talk about it, which doesn’t surprise me, but to see so many commenters (save for a few) focused solely on what takes place in the hospital vice the bigger economic and societal hurdles that Liz cited – it’s frankly disappointing.

    Stop sniping at each other for what happens (or doesn’t) in the hospital, and start talking about what needs to happen in the workplace and in the world.


    1. Agreed!

      I worked for n international corporate firm when my girls were little. I formula fed…however there was NOTHING for any of us new moms. In fact my very large corporate firm told people to say they were sick when they needed a day/morning off for some kid related duty. I used to get to tell people that. “Our company and executives doesn’t believe in children or families…please pretend you have the flu.” Fun times.

      Of course now I work for a small company. One that won’t pay me for a single day off after having a baby.

      There is something missing in this country and it isn’t that hospitals hand out formula samples.

    2. There -are- big hurdles but you need to understand the importance of the first 48 hours after birth to establishing the breastfeeding relationship. If you don’t establish a good supply within that period, with good latch, no pain, milk starting to come in, all of that, you are most likely not going to breastfeed once you get home. That is why the breastfeeding rate drops off so severely immediately after hospital discharge.

      Once the mom and baby go home home, it IS key to support the mother at home, at work, and every where in between but if the mom doesn’t feel confident in what she’s doing and/or the milk is just not coming in and/or there are actual issues, she’s going to quit well before it’s time to go back to work or even go for the first outing.

      I hear many protesting the choice being removed from mothers, but I happen to believe this gives moms and babies a fighting chance to be successful in breastfeeding when it IS their choice – and 90% of NYC moms DO choose it.

      1. I actually agree with this Danielle. As I said in my post (very specifically) if this effort gives women who want and can breastfeed a better chance at doing so, that’s phenomenal. Provided it’s not at the expense of those who don’t want or are not able to.

        I love the commenters (including you) who mention the education has to start way way before l+d. And obviously the formula marketers should not be the primary source of info and/or pressure.

  42. Living in Canada, in big city, makes me see this move by Bloomberg (or whomever) slightly different. Couple of years back (when I was totally oblivious childless person) there was big campaign and push and couple of medical recommendation changes for Breast is Best. Big billboards, mandatory and free lactation consultant in maternity wards and outside, all paediatricians and nurse with relevant training… and yes, the dreaded “no samples in hospitals” approach. Today, formula is freely available everywhere (including some concealed shelves in hospitals) pretty much every department store and mall has breastfeeding rooms and staring at the public breastfeeding is minimal. (Mat leave is one year, so no pumping accommodations are mandated, just encouraged).

    Before I throw a stone at such government mandate south of border, I have to, just have to look at the stats of diet coke vs. milk in kids. Apparently advertising and easy access works, and works big time. We have successfully replaced nutritious drink with flavoured emptiness that costs 3 times as much. And similar push is happening in hospitals too, formula companies are (currently) having open, unrestricted monopolized market with fresh moms. If that is not “browbeating” into easiest choice, I don’t know what is. And I don’t accept notion that this market is not monopolised just because there are 4 companies fighting for night stand space. It is still a space that *I* should have a say about it, and not hospital/food company. If I want free formula waiting for me there, then is should be there. It should not be “placed” there just because some big food company gave it as “freebie” to a hospital. I tend to think of hospital bed same as my own private bed – I pay for care, not to be pitched more advertising. If government went in and said: your personal nightstand is protected, and nobody can place billboard on it without your say, I don’t think we would be discussing bigger sleep issues. How much advertising I see should be controlled by myself, not by the fact I just had labour. Why is free and available formula samples in hospitals OK, how would we feel if drug companies put free antidepressants next to every hospital bed (since such a big percentage is already on antidepressants, why not; and since we feel nice, the positive effect will help recovery)? I don’t see it as food vs. drug debate here, but as some company somewhere getting benefit (potentially long term ), and I had no say in it.

    But that same government can start using their brains and put proper wording, not “insisting” on choice, but supporting choosing process. And expand it to educate medical personnel and get public opinion tuned – because yes, that is CRITICAL part of puzzle. But, hey, I’m just a layman.

    1. @Marija: This exactly! It shouldn’t be about how parents choose to feed their babies but the fact that I should be able to attend a prenatal appointment or give birth without the nurses insisting I take packs of formula home. If I need it, I will ask. Do not force a product on me that I don’t necessarily want or need.

      I was discussing my weight with my GP last week and she said, “Yes, you’re a little chubby. I can prescribe you a diet pill.” I was flabbergasted that it was her first suggestion. I said no and the next day happened upon a news article about a new FDA approved diet pill. The same my doctor offered… Hmmm… I wonder how much she was paid to offer me that versus giving me recommendation on natural, healthy methods I could try first.

      This formula debate is the same. I should get unbiased information and recommendations from my doctors and nurses. I should not be prescribed or given things that are only offered because the hospital is getting kick backs.

  43. But then what? You are dead on. I wonder if Mr Bloomberg provided lactation breaks for his female employees. I know that when i returned to work with my breast pump i saw a few eye rolls and a male employee commented that my maternity leave was over.

  44. What if I told you that we pretty much have all those things that you wished for in Canada, plus maternity leave too, and our breastfeeding rates are still not that much higher than in the United States.

    More than 90% of women in Canada plan to breastfeed and initiate breastfeeding. But most of them don’t meet their own breastfeeding goals.

    Easy, persistent access to free formula samples and formula marketing combined with insufficient free access to International Board Certified Lactation Consultants (and bad advice from others in place of quality advice) are the main contributors of breastfeeding failure.

    I’m not just making it up. There are numerous studies that point to this specifically and directly, many of which I referenced in this blog post and a more recent one that I wrote about here:

    Until there is an IBCLC on every hospital bed stand table, I don’t think that formula samples have any place there. That isn’t because I think moms need a lecture. It is because I think they deserve a fighting chance to meet their own goals.

  45. Yes! Thank you for this! I refuse to feel guilty that all three of my kids got formula in some form or another. Like others have said those hospital samples saved me!! My kid was starving and I had no idea. Now, that, that I feel guilty about. The formula that fed her when I could not? No way.

  46. Most moms and babies are in the hospital for less than 48 hours, I don’t see how this will make a different one way or the other. Heck, I was there for 4 days with my triplets and my milk had barely come in by th time I left. They packed my bags with three weeks worth of free formula and diapers (hundreds of dollars worth) and I still ended up feeding them breastmilk nearly exclusively. I am so glad for the support I got from the nurses, the doctors, the lactation consultations who encouraged me to try breastfeeding, who told me I could totally do it with triplets. In the long run, those conversations were worth so much more than the freebies.

  47. this conversation is awesome—i feel kind of silly jumping in. but, uh, i guess that’s not going to stop me.

    i’m a staunch pro-breast feeding advocate. i’m happy that formula will be harder to get. (yes, i know what i just walked into, but i’m being honest. if you ask me, a woman who needs to figure out how to feed her child WILL find a way to feed her child. i’ve been there.) i agree that the language is concerning, especially since it seems to reflect the painful judgement that comes with the apparently not-so-simple choice of how we feed our children. and i could not agree more that we do not live in a pro-breastfeeding culture. i know because i’ve felt the wrath of being a formula feeder (2xs). despite nearly every lactation consultant in nyc, two illegal (in this country) prescriptions, an endocrinologist, a breast feeding doctor, feeding on demand and all the rest, i just don’t make enough milk to feed my kids past 5 months old. i had to formula feed and i felt terrible about it. people judged me and, silliest of all, i judged myself. more than being angry at the sanctimonious moms who gave me dirty looks for shaking my formula all around brooklyn (how dare i?!), i’m angry that i was mean to myself. why did i go that far? why was i so fucking embarrassed?! why didn’t i feel like a great mom that i figured out how to help my kids, oh, you know, LIVE instead of starve?! and grateful that i could get my hands on sustenance for them? instead i felt like a total failure one sign, i think, that this has all gone too far.

    but i’m thinking that all of this is not the point, right? though i love hearing all of your stories and feeling our collective passion for being able to make choices judgement free (yes, please!), i find it interesting that when the breastfeeding/formula debate comes up, in any which way, we all start telling our stories (me included; see above) and arguing our relative POVs. but it’s not about our story or the choices that we made for whatever reason. it should be more simple that that, no? it should be about making sure that our babies thrive in the healthiest way possible given their parents choices and circumstances. i love what @cloud said:

    rather than digging into our respective corners about breastfeeding vs. formula feeding, maybe we should work together to come up with wording for the rule that would accomplish the breastfeeding advocates’ goals … while also ensuring that women who want or need to formula feed have access to formula and are not subjected to cruel and counter-productive judgment…

    how do we accomplish this? it’s a huge issue having to do with pre l&d education, post l&d support, support for b’feeding in the workplace, etc. BUT one of the reasons why, despite my issues with it, I support the Bloomberg initiative, is that i’m not sure how we can make any of these strides with corporations smack dab in the middle of it trying to sell us product.

    a huge part of this for me is about food companies pushing product on an uneven playing field. am i sure that locking up formula makes the field even? no, but i do know that they should’t be leading the charge on messaging about what to feed kids. they have no record of a commitment to health, no obligation to provide the public with the best available products and most accurate information about nutrition, and no investment in empowering women to make a choice other than to buy their product. all of these things are fine or at least have a place (er, sort of) on the free market, but in the hospital? how can we make informed personal choices without being able to count on getting fair, balanced information? it’s a small part of the fight, and maybe not the most significant to many, but as a passionate proponent of healthy (balanced!) eating, i think that this is a good step towards giving people space from food companies so that they can hopefully learn more about all of their choices. and when women choose formula, for *whatever* reason, please make it white label, offer a selection of coupons (or tell me where i can get them online—there are many, many options), and make sure that you have organic samples, too, for those of us who make that choice. 🙂

  48. this conversation is awesome. hope i can hang. here goes…

    i’m a staunch pro-breast feeding advocate. i’m happy that formula will be harder to get. (yes, i know what i just walked into, but i’m being honest. if you ask me, a woman who needs to figure out how to feed her child WILL find a way to feed her child. i’ve been there.) i agree that the language is concerning, especially since it reflects the painful judgement that comes with the apparently not-so-simple choice of how we feed our children. and i could not agree more that we do not live in a pro-breastfeeding culture. i know because i’ve felt the wrath of being a formula feeder (2xs). despite nearly every lactation consultant in nyc, two illegal (in this country) prescriptions, an endocrinologist, a breast feeding doctor, feeding on demand and all the rest, i just don’t make enough milk to feed my kids past 5 months old. i had to formula feed and i felt terrible about it. people judged me and, silliest of all, i judged myself. more than being angry at the sanctimonious moms who gave me dirty looks for shaking my formula all around brooklyn (how dare i?!), i’m angry that i was mean to myself. why did i go that far? why was i so fucking embarrassed?! why didn’t i feel like a great mom that i figured out how to help my kids, oh, you know, LIVE instead of starve?! and grateful that i could get my hands on sustenance for them? instead i felt like a total failure. it’s one sign, i think, that this has all gone too far.

    but i’m thinking that all of this is not the point, right? though i love hearing all of your stories and feeling our collective passion for being able to make choices judgement free (yes, please!), i find it interesting that when the breastfeeding/formula debate comes up, in any which way, we all start telling our stories (me included; see above) and arguing our relative POVs. it’s not about our story or the choices that we made for whatever reason. it should be more simple that that, no? it should be about making sure that our babies thrive in the healthiest way possible given our choices and circumstances. i love what @cloud said:

    rather than digging into our respective corners about breastfeeding vs. formula feeding, maybe we should work together to come up with wording for the rule that would accomplish the breastfeeding advocates’ goals … while also ensuring that women who want or need to formula feed have access to formula and are not subjected to cruel and counter-productive judgment …

    how can we work together to ensure that new moms get unbiased info, or at least measured info about all the options, when food corporations with big money are a major part of the equation? and not their philanthropy department! they are a part of the conversation with the explicit intent on promoting their product! i get that this is a small part of a very complicated issue and perhaps an insignificant one to many. there’s still the matter of pre- and post- l&d education, support for breastfeeding in the workplace, and the rest. but, as someone who cares passionately about educating people on healthy food and measured food choices (which, by the way, includes the occasional spoonful, or two, of nutella) i think this is an important issue.

    a huge part of this for me is about food companies pushing product on an uneven playing field. am i sure that locking up formula makes the field even? no, but i don’t think that they should’t be leading the charge on messaging about what to feed babies. they have no record of a commitment to health, no obligation to provide the public with the best available products or even most accurate information about nutrition, and no investment in empowering women to make a choice other than to buy their product. all of these things are fine or at least have a place (er, sort of) on the free market, but in the hospital? how can we make informed personal choices without being able to count on access to non-marketing information? (isn’t marketing inherently biased, no matter how good natured the company?)

    as a passionate proponent of healthy eating, i think that this is a good step towards giving moms space from food companies explicitly pushing product (which is fine-it’s their job!) so that they can hopefully learn more about all of their choices. and when women choose formula, for *whatever* reason, it’s okay with me. just please make it white label, offer a selection of coupons (or tell folks how to get them online—there are many, many options), and make sure that you have organic samples, too, for those of us who make that choice. 🙂

  49. I have a sister who has 3 kids and she feeds them with formula. Giving formula to kids is the only way can a mother do especially those who cannot produce breast milk. Even a worker mother nowadays using this feed method. They do not have enough time for breast-feeding for their kids.

  50. Not every woman can breastfeed. And everyone else who left a comment explained many of the reasons why Mayor Bloomberg’s decision is nonsense. It’s another example of a politician (especially a male) getting involved in women’s and families’ issues that are none of his business.
    And, as always, the key is education, not forced compliance.

  51. Moving back towards a cultural norm that sees breastfeeding as the best way to nourish a child will require more of us to support and encourage the parents around us to be successful at breastfeeding. It will also require that the healthcare professionals develop real skills in helping moms breastfeed successfully.

  52. My sweet daughter is 3 months old has only been breastfed (I just went back to work). I guess I was lucky to be in a hospital (North NJ) who never even mentioned formula. But really I’m commenting to let people know that with the role out yesterday of some of the Healthcare Act ALL businesses with 50+ employees are required to give you time and space to pump. If they don’t you can report them.

  53. excellent points. it is never as simple as people want to think it is.

  54. I’ll tell you flat out why women stop breastfeeding.

    Because it is a solitary endeavor that places additional stresses on women who are already expected it to Do It All at a time when they are possibly most vulnerable and in need of a HANDS ON community who tells them “you should NOT be doing it all right now” and then stands alongside and lets the new mother do what she is supposed to be doing – concentrate on being a new mother.

    I DO NOT CARE if you (general you) were able to to it all, on your own, and have now earned your martyr wings. THAT IS NOT THE WAY IT WAS DONE FOR 10,000 YEARS.

    Women lived in extended communities with their aunties and sisters and mothers and everyone helped out so the new mother could concentrate on just learning the ropes. In the Amish community, they still do this. Amish new mothers have teen neighbor girls who come live with them and do all the chores and cooking for SIX MONTHS. YES I HAVE MY CAPS LOCK ON.

    You can’t talk about “evolution” and “natural” and then pull that from context. Don’t make me turn my caps lock on again.

    So, you know, rant, and rail, and pull formula and tsk tsk women for their choices. I maintain – and HAVE maintained that if people really want new moms to be successful, then get in their homes with them and help them. Be an auntie/sister/mother in real time, making real meals, helping them take real naps during the day so they aren’t so sleep deprived they become psychotic and depressed. You can take away all the formula you want and without real time support, new moms will start pouring cows milk and sugar water in bottles if that’s what keeps everyone sane.

    It’s not easy for everyone, and it is truly impossible for some. That some people were even able to breastfeed in THE MOST difficult situation still does not mean that another mother’s situation wasn’t worse. Stop with the judgment. (Not you, in general.) And just LISTEN to what women who aren’t breastfeeding are telling you without poo-pooing it out of hand.

    OH MY FREAKING GOD this topic makes me insane.

    1. And yet…you sound very sane. Thanks Josette. This is a really really important addition to the discussion.

      1. Thank you Josette. I chimed in earlier in this discussion (I am a bottle feeder), but what you say is exceptional and a reality for many, including myself.

        As a new mom and a perfectionist and a person who believed that I could do it all, I was somewhat cursed when it came to breast feeding. As an only child with NO sisters or sister in laws or basically anyone to help me (my stepdad was a dialysis patient at the time and required a lot of help from my mom)..I thought that I was invincible and I could take care of my most perfect baby boy and vacuum and clean and launder and cook and keep in touch with the support groups that I ran without sleeping/napping or eating.

        Well – when your newborn baby doesn’t poop or pee for 2 days and requires pedialyte because momma is not making any milk because she is running herself crazy and baby is dehydrated at a few weeks old….you suddenly realize that you can’t do it all.

        And I have to say no one said I had to exclusively bottle feed, but rather I did have to supplement for a while and see if I could rest/relax/eat/and boost my milk supply. I know – the bf’ers would say that supplementing would deplete my supply….but when you are so depleted physically – I feel it is a necessity. and boy oh boy did I try to still make it work – and did I wail and cry and panic when it didn’t.

        AND talk about being shamed when breastfeeding in public – I used to hide when bottle feeding in bathrooms and dressing rooms and cars so I didn’t get the stink eye!

        I can’t stand this debate and I can’t tell you how many private conversations I have held over the last 11 years with moms in similar situations as I was…and say cheers to you – because if you (in general) want to promote bf’ing, then go clean someone’s house or pace the halls at night with their newborn so they can rest.

  55. What cracks me up (and seriously, same thing at my blog) is that everyone is going through exactly how they fed their kids and in well, a few years LIKE NOW no one even gives a crap about it.

    They go to school and do you think people are going “Yep, him, he was breastfed, I can tell.”

    I try to remind myself of this when people (including me, at times) get so heated.

    My only regret was that I listened to all the people telling me that I’d be giving in or that formula would tempt me because that made it “bad” and “wrong” that made me a “failure” — shame on them. And shame on me for believing them. I figured it out after a few kids. Not everyone gets that chance.

    1. I’m finding all the discussions you’re having and your posts on whether breast is best really interesting. I know formula feeders who feel guilty about their choice years later, but it’s interesting to see a breastfeeder who is conflicted about hers.

      Thanks Kristen for thoughtful contributions, as always.

  56. My baby was small when born and had low blood sugar. I could not produce enough milk to sustain him right after birth – thus my breast milk was supplemented with formula, which is something we continued even after we left the hospital. He’s a healthy and happy baby and formula was a HUGE help to us – no one should have the right to tell me how I should feed my child.

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