I need to get Ian out of the house, away from Portal 2 and SpongeBob, and into the woods for exercise and fresh air. He's been completely ignored this morning, while I've been promoting my latest Atlantic article.
In the meantime, let me pull out two articles in the Atlantic that really deserve more attention. Good stuff there this week. Open thread on these articles.
I wish I wrote this article about how having a child with a disability really puts the stupid "having it all" notion in perspective. I am actually totally pissed at myself for not writing this article. I may have jealously googled the author.
Also, check out the article about New York City's new pro-breast milk policy.
While you're at it, here are some lovely pictures of naked people.
Apt. 11d 
I find that Atlantic article on breastfeeding to be so f-ing irritating, mainly for its recycling of a lot of the usual anti-breastfeeding talking points. “Blah blah blah some women can’t produce enough milk blah blah blah some women are on anti-depressents and can’t breastfeed blah blah blah.” It’s just so tiresome.
I’ll grant I don’t know the particulars of Bloomberg’s specific plan and I’m too lazy right now to find out. But here’s the thing: any attempt to change the culture of feeding babies is the right thing to do. Breastfeeding is normal. Formula feeding is what you do when you can’t do the normal thing. Like, living without anti-depressants is normal. But since I can’t go more than 2 days without having an anxiety attack when I’m not on anti-depressants, taking Zoloft is what I do. I don’t go around complaining that people think I’m abnormal because I take Zoloft. I *am* abnormal. Having babies or living in Maine f-ed up my brain or something. So what. I’m glad I have Zoloft.
And there were times when breastfeeding wasn’t quite working. The first 6 weeks with S were very hard. I had a LC come to my house. My husband and I used some sort of weird finger-mounted contraption to feed her expressed milk. We supplemented with formula. GOOD. That’s what it’s there for. Eventually, I was able to transition back to full-time breastfeeding. If I couldn’t, I would have used formula. Why? Because formula is a solution to a problem. We shouldn’t run our hospital maternity wards assuming a problem already exists. We should assume that women will breastfeed then use formula when they can’t.
But here’s the thing: it’s not infantilizing to say to women “We keep the anti-depressants locked up, but if you need some after giving birth, we’ll give them to you.” Anti-depressants are what we give when your serotonin receptors are fucked up. Formula is what we give when your mammary glands are fucked up.
What Bloomberg is doing, I think, is changing the culture so that formula feeding is not the norm; breastfeeding is. If the change in culture starts at the hospitals, right after childbirth, it will ripple outward in society. Breastfeeding will be more acceptable, and women will truly have more choices because bonehead bosses, for one example, won’t assume that working women feed their children formula, and then they’ll have to make adjustments that make it easier for women to breastfeed and work.
I can rant some more, if anyone likes. 🙂
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Ha, you can tell when even my own writing about the topic is irritating me because I started forgetting to bleep myself. 🙂
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We should assume that women will breastfeed then use formula when they can’t.
How do you stop the staff from assuming that until the baby needs to hit the NICU.
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“How do you stop the staff from assuming that until the baby needs to hit the NICU.”
By hiring qualified professionals?
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As near as I can tell, the sole qualifications for a lactation consultant are a willingness to say “Try harder” and the possession of some pamphlets.
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Yes, that article made me rant, too. From what I can tell, there’s going to be some kind of city regulation that prevents hospitals from offering free formula unless it is requested.
I’m not sure the analogy is anti-depressants. My comparison might be the difference between a hospital offering free fruit or free twinkies
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What woman gives birth and then never sees a medical professional except for a lactation consultant?
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You need lactation consultants because nurses and doctors and midwives aren’t trained in lactation. They advise based on their own personal experience. Kinda like a pediatrician giving parenting advice. Knowing the medical side of children doesn’t equal knowing hiw to parent.
I agree with Wendy – if it starts us back to breast feeding being the norm, then great. And the biggest step to making it easy is paid longer mat leave. You can’t put women in a crazy making double bind of “must breast feed” while also requiring “must do paid work immediately”.
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What woman gives birth and then never sees a medical professional except for a lactation consultant?
I was mocking the consultants because I found my wife’s especially useless. My point is that pushing breast feeding can lead to problems and a great deal of stress when it fails and that maybe listening to the mother, as opposed to a professional, might be a good idea. Our professionals didn’t listen to the mother until the baby turned yellow.
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I don’t know who your wife’s LC was or what their credentials were. I think it’s interesting that you blame the LC and not the pediatrician. Why shouldn’t the pediatrician be held accountable for not ensuring your child’s health? The LC’s only job is to teach a woman how to breastfeed, not to ensure a child’s health. The pediatrician should have been doing his or her job, and it sounds like s/he wasn’t. S’s pediatrician was awesome. He told me exactly what I should be looking for to ensure that S was healthy even though I was having tons of problems breastfeeding in the first 6 weeks. He told me to come in to see him if x, y or z happened. He was very positive.
I’m sorry your kid’s pediatrician failed you. 😦
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I don’t blame the pediatrician because the pediatrician is the one who took a look at the baby (his first look as the baby wasn’t even 48 hours old) and ordered formula.
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MH said…
“As near as I can tell, the sole qualifications for a lactation consultant are a willingness to say “Try harder” and the possession of some pamphlets.”
Amen to that. I’ve seen a couple of lactation consultants as well as pestering a lot of hospital nurses without noticeable effect. My oldest lost a lot of weight initially and couldn’t sleep (of course not–she was hungry and ticked off) and the pediatrician’s office set us up with a pump what felt like years (but was only a couple of days) later. I was really feeling very hostile to her up until that point, thanks to all the hungry crying and sleeplessness. I pumped for a year and never got back to actual breastfeeding. With my second, I was at a better-staffed hospital. I struggled faithfully and eventually just buzzed the nurses to help with latch on every two hours. One nurse (out of the half dozen or so) said something about the baby needing suck training. I spaced out on that at the time because nobody else said anything similar (including the lactation consultant we eventually hired), but now I wonder if that wasn’t the problem. The physical pain was indescribable. We went to a pump quickly that time, knowing that it was the road to sweet dreams and warmer feelings toward the baby, and I pumped for a year again. Once again, I felt much happier with the baby when released from trying to feed him without a bottle. I will try a lot harder with professional help at the beginning this time, because I don’t think I can face a third year of pumping while neglecting the baby, not knowing if it’s really worth the neglect and the interference in family schedule. It’s going to have to be a very big, expensive push, I’m afraid, and may involve hiring a post-partum doula. It will be ridiculously expensive and it may not work at all. That sort of expense is simply not feasible for the sort of women Bloomberg has in his sights. Bloomberg isn’t mandating that nurses show up every two hours to help with latch on or sending lactation consultants to spend mornings with new mothers–he’s just literally locking up the formula. Little as he realizes it, he is inevitably going to contribute to dehydration, possible starvation, abuse, neglect and dead baby cases. Without considerable support, that’s where this policy leads. If I, a married, middle-class mother who wants the baby and has access to excellent medical advice can feel hostile to a hungry new baby because of sleeplessness and pain, how much more so is the same true of women in much more troubled circumstances? Formula-feeding is the best that we can expect of a large percentage of American mothers, and it’s really not that bad.
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MH, there is so much wrong with your understanding of what was going on. This is precisely why we need to make breastfeeding the norm. First, there was nothing wrong with the breastfeeding. Undoubtedly, your wife’s milk hadn’t come in within the first 48 hours (took me 5 and 4 days with my kids).
Formula can reduce jaundice (which I’m sure you know is a build-up of bilirubin). When the mother’s milk comes in, and the baby starts taking in more fluids/nutrition, the jaundice will ease. There is a fine line between knowing when precisely formula is needed, when the jaundice might negatively affect the baby’s health. Your pedi sounds a little more cautious/old-school and went straight for formula. This is probably another case where insurance companies get in the way. Would the insurance company pay for a few days in the hospital for your wife while they waited for her milk to come in and make sure the jaundice went away? Probably not, so he prescribed formula, so your wife could leave the hospital sooner. Probably in the old days, there were “wet nurses” who provided milk for babies in these circumstances until the woman’s milk came in, but we’re way too squeamish for that kind of thing these days.
Feel free not to answer this, but I am curious to know if your wife continued to breastfeed or just used formula. But if she thinks she “couldn’t” breastfeed, that was *definitely* not the case, if you’re basing your conclusion on the first 48 hours!
I really am not the most militant person in the world on breastfeeding issues. But to me, so much of this is simple common sense and being pragmatic.
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“I’ve seen a couple of lactation consultants as well as pestering a lot of hospital nurses without noticeable effect. ”
Hospital nurses aren’t usually “real” lactation consultants, I’ve found. They took a class or something, and they’re usually nice, if overworked, people. The professional LC I saw once I went home was much better.
Btw, cutest story about my FIL: My FIL was almost definitely autistic, which we didn’t quite realize till E ended up just like him. Very socially awkward, rarely said 2 words to me. But when he found out from my MIL that I was having trouble nursing S, he actually asked around at his workplace (BAE Systems!!!) and got the name of an LC and *called me* to give me her number! It was one of those things that, even in my darkest moments, I’d think, “Well, even Al wants me to succeed!”
I have to say, I wouldn’t pump exclusively for a year, so more credit to you for doing so. I worked (when S was a baby) and pumped, but it was only part of the time.
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I really am not the most militant person in the world on breastfeeding issues.
That’s kind of scary then. Would my wife have wanted to stay a few days in the hospital when a 1/2 cup of milk solved the problem entirely? That’s not even sane leaving aside costs. And gets to what bothers me most. There was enough monitoring that there was never any serious danger to the baby, but the pain and stress of the mother counted for nothing in this. All this effort to avoid a substance on which nearly every person in my age cohort subsisted on for a year or more of their life. Clearly, there is evidence that breast feeding is healthier, but I’d like to see a NNT* for some positive outcome past the first year of life.
Things went fine afterward, feeding-wise.
* That is “Number Needed to Treat.” There are a great many things that lead to positive outcomes in a study but nobody bothers with because you have to treat 10,000 people get a case where the treatment matters.
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“I don’t blame the pediatrician because the pediatrician is the one who took a look at the baby (his first look as the baby wasn’t even 48 hours old) and ordered formula.”
Yeah, 48 hours is the usual interval for seeing the pediatrician the first time (I had never met the . Then it’s two weeks, right?
Since this is NYC we’re talking about, wouldn’t the population be bifurcated between bohemian/upper-middle class mothers on the one hand, and low-income minority women on the other? I’ve heard that low-income black women do not breastfeed, while Latino women often do. I think there’s little harm (as well as little point) in pushing breastfeeding in populations where the practice is well-established, but potentially a great deal of harm in pushing it in populations where 1) there are not a lot of economic resources and 2) the mother is unlikely to have a lot of support and well-informed breastfeeding help from family.
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I nursed both of mine, still am the little guy, fought through jaundice, mastitis, etc. etc. etc. I’m happy to live in Toronto where thanks to serious mat leave and public health, breastfeeding is a norm. I’m all for making breastfeeding a viable option.
That said, I think this is a dumb policy. It just punishes people who least need it.
The real barrier to breastfeeding in the US is probably mat leave – if you have to go back to work in 2 weeks and pumping is hard at work and going to wreck your sleep why would you?
I really don’t believe there’s enough difference between breastmilk/feeding and formula to justify the vilification of formula (See Hannah Rosin’s piece in the Atlantic from a while back: http://www.theatlantic.com/magazine/archive/2009/04/the-case-against-breast-feeding/7311/ ); it’s another one of the moves towards “perfect parenting” where you must provide not just a good experience for your baby but The Ultimate Optimal Experience As That One Study Showed This Might Be.
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“Hospital nurses aren’t usually “real” lactation consultants, I’ve found”
In the hospital I saw actual lactation consultants in addition to the nurses and then we saw lactation consultants at the pediatricians’ offices. So, I guess that makes a total of at least four real LCs that I saw. It never seemed to do any good. (I now think that there really was probably some undiagnosed anatomical issue–maybe tongue-tie?) I’m going to talk to my OB this time around and pick her brain. Especially with our first, we were really caught unprepared–she was born at 37.5 weeks and we hadn’t booked a pediatrician or packed a bag, although we had taken all our new parent classes. With the second, I even did a prenatal visit to the LC to see if there were issues on my end. Didn’t do any good, though (that might even be a fifth LC that I’ve seen).
(Here’s a funny LC story. I was at our very first pediatrician’s office with the LC explaining our problems, and she asked something like, “Do you and your husband do XYZ while having sex?” I guess the idea was that she was wondering if I had some sort of hang-up with the idea of using the breast for nutrition due to recreational associations. That was also the LC who wanted me to tell the baby outloud that it was OK to hurt me, or similar verbiage. Of course, the head of pediatric the practice was a guy who would say stuff like “newborns fart like truck drivers” to parents he was meeting for the first time. I moved on to a different practice as soon as our initial feeding issues resolved.)
“I have to say, I wouldn’t pump exclusively for a year, so more credit to you for doing so. I worked (when S was a baby) and pumped, but it was only part of the time.”
I couldn’t have done it without my husband’s flexible academic schedule, especially the second time around.
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“Would my wife have wanted to stay a few days in the hospital when a 1/2 cup of milk solved the problem entirely? ”
Well, if we had the French health care system, your wife would have been sent home, and a doctor or nurse would make house visits. 🙂
I think it’s clear from my post that if I thought a 1/2 cup of milk would have solved the problem, I would certainly have done it. I had no problem with formula supplementation in the case of a problem, and jaundice is a problem (easily solvable, but a problem). But I wouldn’t have blamed breastfeeding or claimed I couldn’t breastfeed.
“but the pain and stress of the mother counted for nothing in this.”
Relieving pain and stress is a function of her support network. A qualified support network would have been able to reduce her stress and maybe even her pain. The pediatrician should have told her “Oh, we’ll give formula, but keep nursing, and when your milk comes in you can go back to it.” Not a big deal.
I’m not militant in that I don’t feel this way because of some sort of values. To me it’s all about misinformation and misunderstanding, and that drives me *crazy*. It’s not that we share different values or opinions. It’s that you simply don’t understand breastfeeding and thus are basing your conclusions on misinformation.
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You can read the complete initiative here (PDF). It’s not a rule or law. It’s an initiative, and it’s voluntary on the part of the hospitals:
“The initiative includes the following components:
– A call to all NYC maternity hospitals to make a voluntary commitment to support mothers who choose to breastfeed by:
– Enforcing the NYS hospital regulation to not supplement breastfeeding infants with formula feedings unless medically indicated
– Limiting access to infant formula by hospital staff
– Discontinuing the distribution of promotional or free infant formula
– Prohibiting the display and distribution of infant formula promotional materials in any hospital location
– A public awareness campaign to promote the health benefits of breast milk, and to inform women of their right to receive education, encouragement and support to breastfeed their babies if they choose to do so.”
Seems pretty benign to me.
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“Relieving pain and stress is a function of her support network. A qualified support network would have been able to reduce her stress and maybe even her pain”
But they were seeing a lactation consultant, who wasn’t managing to reduce stress and pain. Everybody says, “See a lactation consultant!” but they’re not magic.
There’s a lot of fog in early parenting, which is why I’m not surprised that MH’s memories of the period may be a bit confused. If I could venture to recreate what happened, I bet it looked something like this:
1. The baby looks terrible! The baby’s sick!
2. The baby’s going to be OK!
3. Let’s just keep doing whatever it was that made the baby OK.
I’ve lived through roughly that same sequence of events twice (without #1 being so severe), and once you’ve found something that works and you’re no longer in baby hell, there’s no desire to jump back in again.
On reflection, I wonder if there isn’t a need for more pre-delivery contingency planning to talk about what to do if things are going badly with feeding. Also (and this is somewhat Big Brotherish) I think that the first pediatric appointment needs to be scheduled before the baby is discharged from the hospital, just like a lot of hospitals won’t let you out without a car seat. I have a hazy recollection of getting our oldest to the pediatrician a day or two later than advisable, as we were surprised by the early delivery and were a day late and a dollar short generally (we forgot to pay our rent that month, too and got a sheriff’s notice on the door, which was embarrassing).
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– Limiting access to infant formula by hospital staff
That makes it somebody’s quantifiable outcome and source of pressure on the staff.
I think that the first pediatric appointment needs to be scheduled before the baby is discharged from the hospital
That happened for us.
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“Seems pretty benign to me.”
But note what’s not there. They don’t say that each breastfeeding mother will see a hospital LC at least twice a day or that they’ll make sure each breastfeeding mother leaves with a tube of Lansinoh and some helpful phone numbers and a working knowledge of what to do over the next several days. It’s almost purely negative, as if taking away the formula were the same thing as ensuring breastfeeding.
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Not giving formula from a locked cabinet is a quantifiable metric. Ensuring breastfeeding really isn’t.
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I went back to work when our second baby was 11 weeks old and I am basically a really self-conscious, shy person when it comes to my body. I was really embarassed about the pumping and the leaking and the times when you sit in a meeting hoping you won’t leak, etc. especially when I was the only female employee in management.
Also I had a job where I was out of the office alot of the time, paying calls on various people, in other buildings which belonged to the corporation, etc. I had a really hard time hanging in there until the six month mark — and no, taking the formula away would not have solved any of those problems. Though honestly, I’m not sure what else would have, either. (Part of me wants to find a baby and latch him onto Mayor Bloomberg for six months, interrupting him at 2 hour intervals during that period including the middle of the night and periodically barfing on him just so he can establish his creds before he starts giving nursing mothers advice, but maybe that’s just me.)
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“I wonder if there isn’t a need for more pre-delivery contingency planning to talk about what to do if things are going badly with feeding.”
This isn’t a bad idea. Being the kind of person I am*, I was thinking about BF when I was 3 months pregnant (my friend S used to joke that I never lived in the moment; I was always planning for 6 months in the future). But a lot of people don’t.
*People think I’m a pessimist because I never assume everything is going to go well, but it actually makes me happy and optimistic because I know I’m prepared. for all the worst-case scenarios. Which reminds me that I need to map all the major hospitals in Berlin for next week. 🙂
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“Which reminds me that I need to map all the major hospitals in Berlin for next week. :)”
Not a bad idea. Grocery stores and pharmacies would also be a good idea, but you’ve probably done that already.
(My sister had a harrowing tale of running out of diapers on a Sunday in Germany during her son’s toddler days. Just about everything is closed on Sunday. I forget how the story ended, but it was probably like Run, Lola, Run, except with diapers.)
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All three Raggirls breastfed until around their second birthdays, so there’s definitely no-anti-breasfeeding animus here, but I agree with a lot of what Hannah Rosin wrote in her anti-breasfeeding screed from a few years ago.
http://www.theatlantic.com/magazine/archive/2009/04/the-case-against-breast-feeding/7311/
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With all the renewed interest in healthful eating/the Paleo diet, it seems ironic to me that people would contend formula is just as good as breastmilk yet insist on eating a Paleo diet and/or eliminating processed foods. It doesn’t get any more “Big Food” than Nestle.
“Part of me wants to find a baby and latch him onto Mayor Bloomberg for six months, interrupting him at 2 hour intervals during that period including the middle of the night and periodically barfing on him just so he can establish his creds before he starts giving nursing mothers advice, but maybe that’s just me.”
How do you explain me, then? 😉 Also, the thing with Bloomberg is that I suspect he is a delegater who hires the best people then supports their initiatives. Just like his bike lane plan is due to the vision of his Transportation Commissioner, he probably has a Health Commissioner whose brainchild this probably is. (Just used the Google, and the current Health Commissioner, Thomas Farley, was trained as a pediatrician.)
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There’s always another fad diet down the line. As near as I can tell, 95% of those doing Paleo are basically looking for an excuse to eat bacon and the rest are more annoying than vegans.
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The reality is breastfeeding is hugely expensive for the women who can least afford it: Those in non-pumping-friendly jobs where they don’t get long leaves and are living paycheque to paycheque.
These are precisely the women who need the samples, need the hospital support in feeding their baby _however_ they are feeding the baby, who probably can’t afford LCs and for whom a pump represents a significant financial barrier. Behaving as if they are handing out Twinkies is ridiculous.
Formula saves lives. It saved mine; my mother had a massive blood clot 3 days after delivering me and she had to be anti-coagulated.
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WIC seems to offer pump loans in a lot of places, which is nice.
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Bacon, sausage, or other cured meats aren’t actually part of Paleo. You are thinking of Atkins.
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I’m not at all on Paleo or Atkins (I ate a pizza for lunch), but we still get uncured bacon.
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Seeing what most toddlers or younger are fed on the public transportation I take, it seems like either breast milk or formula (or really any milk) would be a big step up. I just spent a 2 hour bus ride watching a mother feed her one year old daughter koolaide and sweetened iced tea out of a bottle. Food included starbursts broken into toddler-sized chunks. I routinely see kids not old enough to walk drinking soda and other highly sweetened nutritionally empty beverages. I agree that breast feeding should be encouraged and made easier, but it also seems like a year of formula vs. breastmilk isn’t going to do much when followed by a diet of total junk food.
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“I just spent a 2 hour bus ride watching a mother feed her one year old daughter koolaide and sweetened iced tea out of a bottle.”
Yep.
My baby brother got jello bottles when he was a little guy from our generally rather conscientious mother. Of course, he was an underweight baby and toddler and he had trouble with cow’s milk.
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I just spent a 2 hour bus ride watching a mother feed her one year old daughter koolaide and sweetened iced tea out of a bottle.
Down here in the uncivilized wilds of South Jersey, we have a local soft drink called “Take-A-Boost” (tastes like flat coke). Parents put it in their kids’ bottles. When you see a poor adult with sad, tiny, misshapen teeth, your first thought is always “Boost Mouth.”
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“My sister had a harrowing tale of running out of diapers on a Sunday in Germany during her son’s toddler days.”
Train stations. Travelers’ needs are a big exception to the blue laws in Germany, and many train stations have seized the opportunity. Also, the nearest apothecary (and there’s almost always one within sight wherever you go in Germany) will either be open or have a sign giving the address of the nearest one that’s doing emergency coverage for that day. (Also works for after-hours pharmaceutical needs.)
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Sorry, just two more links.
1. Did you know many hospitals lock up the ice packs?
2. A real person who works in NYC hospital maternity wards.
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