How to Support Breastfeeding without Demonizing Formula

The most positive changes made in the world are not against something but for it.

It can be very tempting to further the normalization of breastfeeding by demonizing formula, or worse, by demonizing formula-feeding mothers.  It calls to you.  The information's right there, and, if you breastfeed, it makes you feel better about yourself and better about your struggles and your hard work to bring it up.  I remember!  It's so tempting to respond to the Similac recall with "Serves you right, you should have breastfed" or "Boobs don't have bugs, this is mom's fault."  Formula sucks.  The educated, informed women who read this stuff already know that.  Most of us tried to breastfeed, and we hate that we're giving our babies crap. 

Attacking formula-feeding mothers is incredibly detrimental in a number of ways, but the biggest one is that you potentially lose very strong allies by doing so.  Me, for example.  My nursing in public post has now been read by over 30,000 people in a month (squee!).  That's good for breastfeeding. We all need formula-feeding moms on the side of babies and boobs.

Some of the strongest advocates in the intactivist movement are mothers who circumcised their first children.  Marilyn Fayre Milos, for example.  Some of the strongest advocates for gentle discipline are those who chose corporal punishment first.  Some of the strongest proponents of natural birth are those who experienced an over-medicated labor or an "unnecessarian".  Many cloth diapering mothers chose cloth because their babies' bottoms reacted badly to disposables.

Many lactivists have never fed their babies an ounce of formula, and some (certainly not all) really seem to enjoy making that fact very known.  They should be proud, but sometimes comments cross the line.  Formula-feeding mothers are referred to as "lazy", "selfish", "lame", "stupid", "irresponsible" and worse.  I'm not pulling this from my own imagination; I am a member of many natural parenting groups and have seen all of these accusations in the last month.  I am not an advocate for formula-feeding, any more than I am an advocate for cesareans.  I believe that supporting breastfeeding means supporting breastfeeding.  No more, and certainly no less.

So, if you want to be a lactivist without pissing off us lazy, irresponsible mothers who didn't try hard enough (ha-ha-ha-ha-ha), what else can you do? 

How to Support Breastfeeding 

Without Being a Boob

Support nursing in public

I've talked about this one a lot.  'Nuff said.

What you can do: If you are a breastfeeding mother, unashamedly nurse in public.  If you can't, thank or at least smile at women who are.  Tell the nursing mama that she's welcome to nurse in your living room if she wants to, and she doesn't have to cover up if she doesn't want to.  If someone brings up the topic of breastfeeding in public, make your views known, don't stay silent.  If you see a nursing mother being asked to leave a public place, come to her aid and fight the flight attendant for her.  Support laws that protect nursing mothers.

Support longer, paid maternity leave

Compared to the rest of the developed world, the USA has an embarrassing maternity leave policy.   There is no paid maternity leave on a national level.  FMLA guarantees 12 weeks of time off every 2 years, without pay, but only if you work for a company with more than 50 employees (in the same state) and have worked there for at least a year.   Unpaid.   If you work for a small company, just got a new job, or (gasp) have another baby less than 2 years after your last, you're likely out of a job, permanently, if you take leave at all.

Some states extend temporary disability benefits for 6-8 weeks, at a paltry 60% of base earnings, with a low cap.  Other states provide nothing.  A well-off family can budget for this time, but eventually, the savings run low.  A single mother who works at a small company has no real choice - either she goes on welfare or goes back to work.  A two-income family, living paycheck-to-paycheck may have no choice at all.

Conversely, Norway and Sweden offer 13-16 months of paid maternity leave at 100% of base earnings.  The rest of Europe averages between 16 and 26 weeks (6 months), also paid at 100%.   Maternity leave in most of these countries is compulsory - you can't go back to work 3 weeks after your baby is born, even if you "want" to.

There is a direct correlation between the length of maternity leave and breastfeeding success. 

• University of California: "A maternity leave of < or =6 weeks or 6 to 12 weeks after delivery was associated, respectively, with a fourfold and twofold higher odds of failure to establish breastfeeding and an increased probability of cessation after successful establishment"

• University of Melbourne: "Mothers who returned to work full-time within three months of birth were twice as likely to have stopped breastfeeding by the time their baby was six months, than those who were not employed.  Mothers who returned to work full time between three and six months of birth were three times as likely to have stopped breastfeeding by the time their baby was six months than non-employed women."

When Canada extended maternity leave from 6 months to one year, they saw a large increase in infants who were successfully and exclusively breastfed.

What you can do: Contact your congressional representatives - both senators and representative.  Contact your local state representatives and senators.  Let them know that you support paid parental leave and extension of FMLA to include all employers and employees, and to extend to at least 52 weeks.

Support certified lactation consultants

 Poor medical advice for breastfeeding is pervasive through the system.  Certified lactation consultants can save a breastfeeding relationship.  Unfortunately, they are expensive to hire, and their services are not usually covered by medical insurance. 

A lactation consultant can take a mother from the brink of quitting to a healthy, happy nursing relationship.  She can save damaged, bleeding, painful nipples.  She can fix bad latches and bad positioning, she can un-advise against bad advice.  She can make magic happen - if she is given the opportunity.

The average visit to a lactation consultant costs $250-$300 - and while it's certainly cheaper than a year's worth of formula, to the low-income mother on unpaid maternity leave, it might as well be a million bucks.  After all, formula is covered by WIC.  LCs are a luxury that many women cannot afford.

Further, they're not that easy to find.  Sure, if you're part of the AP community, you know the names of a few off the top of your head - but where would the average mother get this information?  I hadn't heard of lactation consultants until I started to really research...and not all mothers research.

What you can do:  Call your insurance company and ask if they cover lactation consultants.  If they don't, ask why not, and ask how you can complain in writing.  Make sure your pregnant friends know the names of LCs in their area.  Provide a list of LCs to your local hospitals, visiting nurses associations, YMCAs and OB offices.  Post the date and times of local LLL meetings on community bulletin boards and in supermarkets.  Provide that information to teen mother support groups.  If you are a LC, consider donating some of your time or offering low-cost services, even on a group basis to low-income mothers.

Support gentle birth

Getting a good start at breastfeeding is so very important.  Maternity leave, lactation consultants, and pediatrician support only work if a mother begins her breastfeeding relationship right.  Baby-friendly hospitals are a start.  Baby-friendly hospitals aim to have a 100% breastfeeding rate, and they educate staff appropriately.

1 -	Have a written breastfeeding policy that is routinely communicated to all health care staff.
2 -	Train all health care staff in skills necessary to implement this policy.
3 -	Inform all pregnant women about the benefits and management of breastfeeding.
4 -	Help mothers initiate breastfeeding within one hour of birth.
5 -	Show mothers how to breastfeed and how to maintain lactation, even if they are separated from their infants.
6 -	Give newborn infants no food or drink other than breast milk, unless medically indicated.
7 -	Practice “rooming in”-- allow mothers and infants to remain together 24 hours a day.
8 -	Encourage breastfeeding on demand.
9 -	Give no pacifiers or artificial nipples to breastfeeding infants.
10 -	Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic

I'm going to add on steps 11-20:

11 -	Limit interventions in labor to those that are truly medically necessary for the health of mother and baby.
12 -	Do not circumcise baby boys or girls for non-medical reasons.
13 -	Encourage mothers and babies to attempt the "breast crawl" after delivery.
14 -	Teach baby-wearing
15 -	Provide safe co-sleeping guidelines
16 -	Arrange for lactation consultant follow-up home visits after discharge.
17 -	Provide midwifery care for lower risk births.
18 -	Provide prescriptions for breast pumps to be covered as durable medical equipment by insurance
19 -	Encourage immediate and prolonged skin-to-skin contact, as well as a gentle post-birth environment.
20 -	Skip the hospital  If you are low-risk, try to give birth at home.

What you can do: If you gave birth naturally or gently, tell your birth story.  Support home birth.  Support midwifery.  Contact your local hospital and ask if they have been certified "baby-friendly" by the WHO.  If not, ask why not.  Drop off breastfeeding information at your local maternity ward and at your OB's office.   Support the right to genital integrity and openly oppose routine infant circumcision. 

Support the re-education of medical professionals

The worst breastfeeding advice I have ever heard came out of the mouths of medical professionals. 

• "Only feed for 10 minutes on each side, any more is unnecessary." 
• "Only nurse every 3-4 hours, any more and he's using you as a pacifier."
• "We have to give her formula until your milk comes in."
• "You can't have a glass of wine if you're nursing."
• "Pregnant women's milk is not good for older babies.  You need to wean."
• "After 6 months, there is no nutritional value to mother's milk; it's just for comfort."
• "One bottle of formula won't hurt anything."
• "Breast milk doesn't have enough vitamins.  You need to give your baby vitamins unless you formula-feed."
• "You can't breastfeed if you take_____ medicine" (without checking if it is actually true)
• "Your baby isn't growing fast enough.  You need to supplement with formula."

Sometimes, there is a real, medical reason to stop breastfeeding or supplement with formula.  That is rare - but the majority of women trust their doctor over their own gut feeling or their own research.  Medical professionals need to be educated on the facts.  More breastfeeding relationships have been ruined by pediatricians, nurses and obstetricians than all the free cans of formula in the world.   One bottle of formula *does* harm a nursing relationship.  Nursing on-demand really means on demand!  It is so hard to question your child's doctors.

Every new breastfeeding mother I know has worried, "how do I know my baby is getting enough food?" especially because all newborns seem hungry all the time.  One statement from a doctor about low percentiles or supplementation can be the beginning of the end of a healthy relationship.  Doctors need to be educated about alternative ways to increase supply if there really is a problem - and need to realize that formula should be the last resort, not the first reaction.

What you can do: Talk to your pediatrician about breastfeeding.  Invite local pediatricians to attend LLL meetings.  Encourage your local hospital to adopt baby-friendly policies.  Make sure every pregnant woman knows how to find accurate information.  Bookmark KellyMom.com on her computer.  While you're at it, send the link to your pediatrician.   Write to the AAP whenever you hear a doctor saying something untrue about breastfeeding, to encourage further training.

Support nursing rooms in workplaces, schools, and public buildings

Nursing rooms are common in Malaysia. 

Not all women are comfortable nursing in public.  Nursing rooms are a wonderful amenity that should be as available as bathrooms.  Many laws (but not all states) require that nursing mothers be provided a clean, safe and comfortable place to pump in the workplace....but this is rarely true.  Most moms end up pumping in bathrooms, spare conference rooms, supply closets or cars. 

Schools are especially key - not just for the teachers, but also for the students.  Breastfeeding rates among teen mothers are appalling.  Not all mothers are happily married stay-at-home mommies.... in fact, most aren't.  Supporting nursing and pumping means supporting it in high schools, Walmart break rooms, and your local fast food joint.

What you can do:  If you work, ask your HR department about space for nursing mothers.  Contact your local high school and encourage the school to set aside a room for mothers to pump or nurse.  Ask at your local government building.

Support breast milk donation

There are real, undeniable, and unavoidable reasons that breastfeeding may not be possible, including but not limited to:

• Death or incapacity of the mother
• Inability of the mother to produce sufficient milk, due to PCOS, insufficient glandular tissue, mastectomy, etc.
• Adoption of a child (before re-lactation or if it is not possible)
• Medical conditions that require unsafe medication to manage

Babies should be able to drink human milk, even if their mothers can't provide that milk to them. 

Unfortunately, "official" milk banks are extremely selective and extremely expensive.  I contacted two when I had to stop breastfeeding, and I was told that milk was reserved for sick babies, and that even if they had some, the price for the milk was $3.50 an ounce and not covered by insurance.  For a baby who eats 32 ounces a day, that is simply impossible - and we are a well-off family.

Between then and now, a new organization has come onto the forefront, Eats on Feets, which will connect nursing mothers with women like me, who need donated milk for our babies.  It's still in its infancy, and private milk donation has a long way to go toward being socially acceptable again, but it is a place to begin.  Right now, there is less milk than women who need it.  

What you can do:  Donate any extra milk you have.  Support Eats on Feets.  Talk about breast milk donation, and challenge gut reactions that it's "icky."  If your local EoF is active and has milk available, reach out and let folks know it's there for the taking.

Support media exposure of breastfeeding

1977, Buffy explains breastfeeding to Big Bird.

Bottles are everywhere.  Every time you see a baby on TV, you see a bottle.  Children's cartoons are filled with bottles, but nursing is taboo.  This is an echo on nursing in public, and all the same reasons apply.  Normalizing breastfeeding means that it has to make its way onto television.

What you can do:  Contact PBS and ask them to run another special on television.  Every time you see a baby bottle on TV, comment online at the station and on facebook/twitter.  If you do see nursing on TV, send a compliment (I sent one to the director of  "Four Christmases", which was the first movie I've ever seen with casual nursing and lots of breastfeeding mentions without being a movie about babies) 

Oppose Unethical Marketing of Formula

Haha, exception proves the rule, right?

Yes, the whole point of this article is not to demonize formula or formula-feeding moms. Demonize the mainstream formula companies as much as you want.  Go for it.  Thanks to these jerks, babies all over the world die, and I fed my kid bugs, while they profit massively.

Formula companies advertise *everywhere*.  Boobs don't get glossy ads in Parents' magazine.  Formula companies are regulated in what they can say, but boy, do they squeeze close to that edge!  "Closer than ever to breast milk" is such a misleading statement.  I can make Coca-Cola "closer" to breast milk by adding DHA and probiotics.  It doesn't make it close.  Obviously, Similac is a better choice for your baby than Coke.  BUT, the difference between formula and breast milk is as far the difference between formula and soda.  

Especially abhorrant are the advertisements in developing countries, where a lack of access to clean drinking water makes formula truly life-threatening.  If you don't have clean water, breast milk is vital to the survival of babies, yet companies like Nestle see opportunities for "new marketshare" and plaster with this messaging.

Even the "Breast is Best" campaign is tainted by formula marketing.  It insinuates that perfect moms breastfeed, but who's perfect anyway?  Breast isn't just best - it's NORMAL.  It's what babies should eat, absent extenuating circumstances.  Ads plastered on TV, in magazines, in doctors' offices and in hospitals make formula seem like the normal choice.  Breast milk isn't a "nice option" like organic foods or designer baby clothes.  It's necessary, normal, and appropriate.  It's how babies were made to be fed.  It's how moms were made.

What you can do:  Boycott Nestle.  If you subscribe to any magazines that advertise formula, write to them and ask for "fair and balanced" advertising that encourages a one-to-one ratio of breastfeeding and formula references in their publication - or better yet, ask that they not advertise formula at all.  If you see coupons or advertising at your doctors' office, ask your doctor why they are advertising formula.

So, are you ready?  This is the harder road, but it's the one that makes a difference.  Invite your formula-feeding friends (if you have any) to join you in a fight for mothers' and babies' rights.  There's a lot of us, and we can actually make something happen....if we don't spend our time pointing at each other.