@ Why fed is best

[jeaniebueller]

We talked a little bit about this topic on the MMM board in the past.

www.slate.com/blogs/xx_factor/2016/09/29/fed_is_best_foundation_is_trying_to_undo_the_damage_of_breast_is_best.html


The breast is best ideology is so ubiquitous, so sneakily persuasive, that even those determined to remain open-minded to feeding options are overcome with guilt and panic when they press that first bottle of formula against their newborn’s lips. I’ve known many moms over the years whose prepartum insouciance was no match for the combination of vulnerability-inducing postpartum hormones and heavily biased lactation consultations offered by their hospitals. In fact, I was one such mom, and I felt like an absolute failure for having to give my son formula before my milk came in. That the alternative was his starving—dangerous for a newborn—did little to put me at ease.



In hindsight, I see how ridiculous I was acting, but I don’t blame myself for it. Following the birth of one’s first child, most of us are not in a good place to challenge orthodoxies on our own. We need both support and easily accessible, evidence-based information to remind us of why giving newborns formula isn’t a sign of weakness, or a lifestyle choice, but a completely sane health decision. The Fed is Best Foundation, a new non-profit created to help educate moms on the risks of starvation for newborns, is trying to fill this role.



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The organization was started by Dr. Christie del Castillo-Hegyi, M.D., an emergency physician who researches newborn brain injury and breastfeeding complications, and Jody Segrave-Daly, a newborn nursery and newborn intensive care unit nurse and certified lactation consultant. The goal: to counter “alarming trends in infant feeding, namely a rise in hospitalizations for feeding complications in exclusively breastfed newborns who don’t receive enough breast milk, including increasing rates of jaundice, hypoglycemia, and dehydration, which can threaten a newborn’s brain.”



Thei group's concern is that the pressure to only breastfeed is bad advice for the many women—Fed is Best quotes one in five—who don’t make enough milk during the first few days of their children’s lives. The statistics are harrowing: ten to 25 percent of exclusively breastfed babies experience excessive weight loss in the first days of life, ten to eighteen percent of exclusively breastfed babies experience starvation jaundice from insufficient milk, and ten percent of exclusively breastfed babies experience levels of hypoglycemia (low blood sugar), which can be associated with developmental complications. Also, the most common reason an exclusively breastfed newborn is rehospitalized is due to problems related to insufficient feeding.



Women are told to avoid formula and bottles in the early days of breastfeeding because, many breastfeeding advocates claim, it might confuse the newborn and make them less interested in feeding from the breast. I was told exactly this in the well-regarded New York City hospital where I delivered. The lactation consultant in charge of giving a breastfeeding presentation to new moms made it sound as though nipple confusion was an inevitability (far from it), and one taste of formula would be a death knell for breastfeeding (actually, it can lead to breastfeeding success.) Here’s how she put it: “the billion dollar formula industry makes formula nice and sweet, so once babies get a taste of that they don’t want anything else.” I knew it wasn’t true, and yet, I couldn’t help but internalize the message.



And so did Fed is Best co-founder del Castillo-Hegyi. In an open letter posted on the foundation’s website, she explains how her attempt to exclusively breastfeed her son led to him going without food for a few days, after which he was rehospitalized and treated in neonatal intensive care unit. Later on, he was diagnosed with multiple neuro-developmental disabilities, which motivated del Castillo-Hegyi to research whether the diagnoses were a result of the short period of starvation he experienced as a newborn. She looked through peer-reviewed journals and “found that there is ample evidence showing the links between neonatal jaundice, dehydration, hypoglycemia and developmental disabilities.” She goes on to suggest that “the answer to the epidemic of developmental disabilities,” including autism spectrum disorder, ADHD, sensory processing disorder, severe speech delay, seizure disorders, and motor impairments, “we are seeing may be found in this vulnerable period.”



Del Castillo-Hegyi ends her letter with a list of recommendations to prevent newborn starvation. These include: a requirement for mothers to hand express milk before they feed to ensure there is something for their children to eat; twice daily weighing for exclusively breastfed newborns in the hospital and at home to ensure they aren’t losing a dangerous amount of weight; daily glucose monitoring for newborns to ensure they are not hypoglycemic; and universal education for mothers on the threats of dehydration, jaundice, and hypoglycemia, as well as the complications that might arise from letting such conditions go untreated. If I had only had the latter, both my son and I would have been more at ease during the first two days of his life as we waited for my milk to come in.

[earlgreyhot]

True story: I regret being an exclusive breastfeeder.

I'm happy that I breastfeed, but that I actively avoided formula is the stupidest parenting mistake I made. And I made it twice, it was when I started giving my DD some formula around 10-11 months b/c I wasn't able to pump for a babysitter and I was like "I'm an idiot."

MODERATION IS THE KEY TO EVERYTHING PEOPLE!

[jr009j]

Sept 30, 2016 8:11:38 GMT -5 earlgreyhot said:

True story: I regret being an exclusive breastfeeder.

I'm happy that I breastfeed, but that I actively avoided formula is the stupidest parenting mistake I made. And I made it twice, it was when I started giving my DD some formula around 10-11 months b/c I wasn't able to pump for a babysitter and I was like "I'm an idiot."

MODERATION IS THE KEY TO EVERYTHING PEOPLE!

Same. I could have avoided so much stress when I was pumping one or two ounces less than I needed a day by just giving DD1 one formula bottle a week. Instead I kept adding pumping sessions and crying.

[karinothing]

Can I ask a random but related question. When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician?

I was just thinking about this because not having a baby in the hospital I am required to see the pediatrician w/in 24 hours. With each of my kids my pediatrician pretty much made us go back every day for a week for a combination of jaundice and just "we want to make sure everything is okay since he wasn't in a hospital" Like it SUCKED going to the pediatrician every single day for a week, but they were also 100% on top of what was going on with feeding. On top of all that I had midwives coming to the house at 24 hours and 48 hours to check on me, baby, and how breastfeeding was going.

So not that I advocate dragging people into the doctor for 7 days straight when they are recovering, but I just wonder if there is some gap in care from when a woman is released from a hospital and when they start seeing the pediatrician. And while I 100% believe that fed is best, I wonder if we could also improve this by having more in home care where nurses or midwives or whatever go to your house no matter what to check on how you and baby are doing (obviously this only works if they are compassionate as well). This seems to be some thing like what the doctor in the article suggests since I am not sure how the blood tests would work without seeing a pediatrician or whatever more frequently after release.

I also think informing parents of the signs and dangers associated with dehydration and starvation is an excellent notion and I am surprised it is not being done already.

[redheadbaker]

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

Can I ask a random but related question. When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician? 

I had DS at 4 a.m. on a Monday morning. We were released that Wednesday evening. We saw the pediatrician at 7 days old for a weight check. 

[karinothing]

Sept 30, 2016 8:22:39 GMT -5 redheadbaker said:

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

Can I ask a random but related question. When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician? 

I had DS at 4 a.m. on a Monday morning. We were released that Wednesday evening. We saw the pediatrician at 7 days old for a weight check. 

So it seems like there is a pretty big gap in care then. At least in your situation.

[frlcb]

I had my daughter at like 5 in the morning on a Tuesday, went home Wednesday, saw the pediatrician Thursday. And again on Friday, and Monday, because of jaundice. In the UK I had my son on Monday, went home Tuesday, and a midwife came to me for the first 2 weeks every couple of days. Then a health visitor would come once a month for a couple of months. No pediatricians unless there was a problem. And in neither situation was I able to breastfeed, even with help. I don't regret that at all.

[gretchenindisguise]

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

Can I ask a random but related question. When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician?

I was just thinking about this because not having a baby in the hospital I am required to see the pediatrician w/in 24 hours. With each of my kids my pediatrician pretty much made us go back every day for a week for a combination of jaundice and just "we want to make sure everything is okay since he wasn't in a hospital" Like it SUCKED going to the pediatrician every single day for a week, but they were also 100% on top of what was going on with feeding. On top of all that I had midwives coming to the house at 24 hours and 48 hours to check on me, baby, and how breastfeeding was going.

So not that I advocate dragging people into the doctor for 7 days straight when they are recovering, but I just wonder if there is some gap in care from when a woman is released from a hospital and when they start seeing the pediatrician. And while I 100% believe that fed is best, I wonder if we could also improve this by having more in home care where nurses or midwives or whatever go to your house no matter what to check on how you and baby are doing (obviously this only works if they are compassionate as well). This seems to be some thing like what the doctor in the article suggests since I am not sure how the blood tests would work without seeing a pediatrician or whatever more frequently after release.

I also think informing parents of the signs and dangers associated with dehydration and starvation is an excellent notion and I am surprised it is not being done already.

Both kids were seen within 24 hours of birth.

We left early with A. Had him on Friday am. Left hospital Saturday afternoon. Pediatrician saw him Friday and Saturday and then we had another appointment set up on Monday. Then I think we went back on Friday for a week visit and back on traditional schedule after that.

[redheadbaker]

Sept 30, 2016 8:23:58 GMT -5 karinothing said:

Sept 30, 2016 8:22:39 GMT -5 redheadbaker said:

I had DS at 4 a.m. on a Monday morning. We were released that Wednesday evening. We saw the pediatrician at 7 days old for a weight check. 

So it seems like there is a pretty big gap in care then. At least in your situation.

I think the gap is typically even bigger -- I think most new babies born in a hospital don't see the pedi until the first well-baby check at 2 weeks. They recommended I go at 7 days because they were concerned with how much weight he lost after birth. 

[dottyblue]

Sept 30, 2016 8:23:58 GMT -5 karinothing said:

Sept 30, 2016 8:22:39 GMT -5 redheadbaker said:

I had DS at 4 a.m. on a Monday morning. We were released that Wednesday evening. We saw the pediatrician at 7 days old for a weight check. 

So it seems like there is a pretty big gap in care then. At least in your situation.

I had DS1 at 8 a.m. on a Saturday.  He saw the pediatrician daily until we were released on Monday around 11 a.m. and we were at the pedi office on Wednesday at 9 a.m.

With DS2, he was born at 3 p.m. on a Monday.  Saw the pediatrician daily until we were released on Wednesday morning and we saw the pediatrician in their office on Friday morning.

So for both boys, in the first 7 days of their life they saw the pedi at least 4-5 times.  But, after that, there was a 3 week gap.  Caused major problems with DS1 because we had undiagnosed tongue tie and he gained ZERO weight from his 1 week appointment to his 1 month.  And I was still resistant to formula at that point.     I was such a mess and I wish someone had been around to help me get over my resistance to formula.  I gave it to DS, but reluctantly at first.  Happily once I realized he was a different child when he wasn't starving.
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[BaliHai]

This is really wonderful. I struggled so much with guilt over formula feeding/giving up on BFing so quickly, and it was only in hindsight that I realized what a load of bullshit it was that I ever felt that way. I've said it before, but I really look forward to guilt-free formula feeding this next baby; I wasted so much time being anxious with DD and I regret it's time I will never get back.

The Fearless Formula Feeder really helped me, too, especially with admitting out loud that I chose formula because I hated breastfeeding. It took me too long to realize that was just as acceptable as switching to formula because I couldn't breastfeed would have been.

[Deleted]

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

So not that I advocate dragging people into the doctor for 7 days straight when they are recovering, but I just wonder if there is some gap in care from when a woman is released from a hospital and when they start seeing the pediatrician. And while I 100% believe that fed is best, I wonder if we could also improve this by having more in home care where nurses or midwives or whatever go to your house no matter what to check on how you and baby are doing (obviously this only works if they are compassionate as well). This seems to be some thing like what the doctor in the article suggests since I am not sure how the blood tests would work without seeing a pediatrician or whatever more frequently after release.

To bring this back to the P of CEP, one of the things that Hillary has advocated for is an increase in home visits for newborns to improve health outcomes.

[pugz]

karinothing my experience was likely not the norm due to her being late term but we were in 2-3x the week after discharge due to weight/jaundice.

[JRo]

karinothing We saw the pediatrician in the hospital and then not again until his one week visit. I had DS on Monday at around 4:30 pm and we were discharged Wednesday at around the same time. To bring it full circle with the article, we stayed until just about the last possible minute because DS wouldn't sleep/we didn't get any rest until I finally gave in and gave him some formula late morning on Wednesday. And then he conked out for several hours and we were able to get some sleep.

DS had formula maybe 2 or 3 times after that over the next several days while we struggled to get his latch right, and then not again until he was 10 months old when my supply dipped. All that to say that a little formula in the beginning didn't damage our bf relationship at all.

And LOL to the LC in the article claiming that formula companies make formula nice and sweet. My breastmilk tasted damn near like melted ice cream, lol.

[Susie]

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician?

My gap was smaller than pp's.  I think her pedi saw her in the hospital on all of days 0, 1, and 2, we were discharged from the hospital @ 2 days old, and she was at the pedi's office for weight checks @ 4 days, 6 days, and 2 weeks, then well baby at 1 month.

They offered to schedule more weight checks, I think between the 2 week and 1 month mark, but we were all comfortable with her weight gain so I declined.

I EBFed Hobbes, and she still has never had formula.  (She is 10.5 months.)  Given the size of my freezer stash at this point, I don't think she ever will.  I think I need to get some distance from BFing before #2 to give some more objective thought to whether this is the right road for next time, because it sure isn't easy, and there is so much pressure, starting right from the baby-friendly hospital setting.SaveSave

[heat40]

My hospital requires the baby be checked within 24 hours by a pediatrician. If you don't have one, they'll have the neonatologist do it. We followed up with an appointment like 4 days after we were discharged, since she lost a little more than 10% of her weight.

I just weaned my baby, at 4 months. I remember whispering to her "I'm sorry" while giving her her first formula bottle. I was never breast is best, so I have no idea where those emotions came from. it was only that one minute though, because then I quickly got used to the ease of formula and didn't care anymore about not breast feeding.

[peggy]

M was born 12/28. She has visit records of 12/28 (day of birth), 12/31 (6lb11oz) for "Feeding Disturbance ~Jaundice Physiologic", 1/4 (7lb 2oz), for "Feeding Disturbance; Followup Exam ~Jaundice Physiologic", 1/10 (7lb 2oz) for "Feeding Disturbance", 1/15 (7lb 6oz) for "feeding disturbance, thrush", and then her one month well visit 1/28 (8lb 1oz).

In hindsight, I should have given the kid some formula OR they should have clipped her damn lip and tongue tie that went totally undiagnosed.

[froggy76]

Sept 30, 2016 8:14:55 GMT -5 jr009j said:

Sept 30, 2016 8:11:38 GMT -5 earlgreyhot said:

True story: I regret being an exclusive breastfeeder.

I'm happy that I breastfeed, but that I actively avoided formula is the stupidest parenting mistake I made. And I made it twice, it was when I started giving my DD some formula around 10-11 months b/c I wasn't able to pump for a babysitter and I was like "I'm an idiot."

MODERATION IS THE KEY TO EVERYTHING PEOPLE!

Same. I could have avoided so much stress when I was pumping one or two ounces less than I needed a day by just giving DD1 one formula bottle a week. Instead I kept adding pumping sessions and crying.

Me too. I put so much pressure on myself. I finally had to give a bottle of formula when DD was 9 months old and I was like, "oh, that was easy!" I would have had to pump for probably 2 hours at that point to produce as much milk. I'm looking forward to breastfeeding kid #2 without the pressure of staying away from formula at all costs.

[atexan]

Gawd, I made myself completely fucking crazy trying to EBF. It did not happen. I did all the things. I pumped after every feed, basically lived skin-to-skin, took supplements, domperidone, oatmeal, water, etc. etc. It was never going to happen. I was at the pedi and/or the LC constantly in those first couple of weeks for weight checks and weighted feeds. Twice a week at first, starting 48 hours after discharge from the hospital, and then weekly. We ended up nursing for 15 months but I was never able to produce more than about half of what he ate. I STILL feel guilty about it, even though there was literally nothing else I could have done, and it is over 3 years later.

I am trying really hard to set myself up for success this time, mentally. I will do my best to give #2 as much milk as I can but I won't kill myself over it and I won't resist supplementing with formula at the very first sign of trouble. I can already feel the obsession and guilt sneaking back in though. :/

[saz]

I wish the pro-formula movement had been bigger/stronger when I had my kids. I felt so much pressure to breastfeed that formula did not seem like an option for me. I exclusively breastfed all 3 for a full year each and hated almost every minute of breastfeeding. It was "just" my feelings, and moms are supposed to sacrifice, right? Ugh. I really feel for women who aren't able to breastfeed. I've encountered a few women in that situation recently, who are incredibly crushed and heartbroken, saying things like "I'm a fuck up as a mother," "I've failed my baby," etc. I feel like I've seen enough evidence to raise my doubt that breast is even better, I hate that we've done this to women.

[ufcasey]

I have yet to meet a mother of a teenager who actively regrets feeding their child formula. Plenty of moms still regret all the self-imposed anguish over BFing and pumping that in the end doesn't matter to them now, they just remember how much it sucked to be all stressed out about it at the time. Of course that's not everyone, some people do have a great, easy BFing/pumping experience. Which is great! Much cheaper that way, that's for sure. But it's not for everyone. And it doesn't have to be 100% either option. Do what works best.

[josieposy]

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

Can I ask a random but related question. When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician?

Keeping in mind that I had NICU grads and they had been in there for 43 days, they were discharged on a Saturday and we had to go to the pedi the following Monday.

[isabel]

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

Can I ask a random but related question. When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician?

DS was born at 1am. We saw the pediatrician from our practice who was doing rounds that day early the next morning. We saw another pediatrician from our practice the following day. After being released on day 3, we went for a follow-up 2 days later, so DS was 5 days old. Then we went back again when he was 2 weeks. After that it became the standard 2m, 4m, 6m, 9m visits or whatever the standard is.

[pinkdutchtulips]

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

Can I ask a random but related question. When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician?

DD was born at 4pm on a weds, we were home by 6pm the next day, no LCs saw me before we left, I had a home nurse visit on day 2 but she didn't ask anything about how feeding was going other than to be concerned about DD's noisy breathing - turns out she had larnxical teacheamalicia. She saw the pedi on day 3 again NO ONE asked how feeding was going. I got concerned bc my milk hadn't come in and saw an LC who told me DD was an 'efficient' eater and not to worry.

When I went back to work when DD was 7 wks she was on half BM/half formula at home and 100% formula at DC bc I wasn't producing enough. Xh guilted me more than anyone about NOT bf since both of his brothers' wives were able to do it w zero problems (helps to have lots of family help and a supportive hubs - I had neither).

[isabel]

I EBF for 9 months. I think we made it to about 10 months with my freezer stash. DS was on formula and solids until 12m and then we switched over to cow's milk. I am DREADING pumping again. I didn't mind breastfeeding and am looking forward to that, but going back to work and having to pump makes me want to cry. I am not sure that I will last nearly as long with this one.

My breaking point with DS was that we went on Christmas vacation for a week and I didn't have to pump because I was with him the whole time. When I went back to work the next week, I started crying when I got into the pumping room. I decided right then that I was done and I weaned off the pump. DS stopped taking the breast at the same time because my supply dropped so significantly. I felt a ton of guilt at first, but it was so much better for my sanity.

Mostly, this time around I just hope I am able to mentally get past formula feeding at whatever point pumping becomes too much for my sanity.

[jln]

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

Can I ask a random but related question. When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician?

I was just thinking about this because not having a baby in the hospital I am required to see the pediatrician w/in 24 hours. With each of my kids my pediatrician pretty much made us go back every day for a week for a combination of jaundice and just "we want to make sure everything is okay since he wasn't in a hospital" Like it SUCKED going to the pediatrician every single day for a week, but they were also 100% on top of what was going on with feeding. On top of all that I had midwives coming to the house at 24 hours and 48 hours to check on me, baby, and how breastfeeding was going.

So not that I advocate dragging people into the doctor for 7 days straight when they are recovering, but I just wonder if there is some gap in care from when a woman is released from a hospital and when they start seeing the pediatrician. And while I 100% believe that fed is best, I wonder if we could also improve this by having more in home care where nurses or midwives or whatever go to your house no matter what to check on how you and baby are doing (obviously this only works if they are compassionate as well). This seems to be some thing like what the doctor in the article suggests since I am not sure how the blood tests would work without seeing a pediatrician or whatever more frequently after release.

I also think informing parents of the signs and dangers associated with dehydration and starvation is an excellent notion and I am surprised it is not being done already.

The pedi came to our hospital room each day we were there, for both of my births. (In 2 different states) then when we were released we went to the pedi at 7 days for a blood draw and weight check.

[starlily]

karinothing

My experience is probably not the norm since both girls arrived early.

DD1 was in the NICU for 5 days. We had a pedi appt 2 days after her release, then the typical 2 week well check.

DD2 didn't need NICU. We were released after 2 days, and she had a pedi appt 2 days later. She was jaundiced at that appt, so then we had daily appts the following 3 days.

LCs saw me in the hospital both times, daily with DD1, but EBF just never happened for me.

[smock]

Our pedi wanted to see new babies around 4-5 days old, after the hospital pediatrician and lactation consultants saw us multiple times during our 48-hour hospital stays. Both times we also did a follow-up visit at 1w, and again at 2w.

It seems like more consistent guidelines for pediatrician visits (or home visits, as suggested above) would be a great first step. First-time mothers in particular have no idea what breastfeeding will be like, or how to know if there's milk in there yet, or how to evaluate a latch. It's so hard to know if "ow, this hurts!" is normal, or a sign that something is wrong. And the scare tactics around "nipple confusion" and "breast is the ONLY choice" just make things worse.

[noeliav]

Sept 30, 2016 8:20:27 GMT -5 karinothing said:

Can I ask a random but related question. When you have a baby in the hospital how soon are you released and how soon after do you see the pediatrician?

DD (hospital birth)
Several times in the hospital because she was "low birth weight" (6lbs even for 38w gestation, so not low birth weight at all), and then within 24hrs after discharge (again, because of the low birth weight and because I asked to be discharged "early"). After the first visit, we were back within 3 days (I don't remember exactly) for jaundice follow-up. I also paid out of pocket for the help of a private lactation consultant because we (DD and I) were having latch troubles and no one else was able to help us fix it. I will forever praise the LC for saving our breastfeeding relationship, *but* I fully recognize how privileged I was to be able to have (and pay for) that help.

DS (birth center birth)
Within 48hrs of birth, then a home visit from one of the BC nurses for me and him, and then again in a week or so.

Both my kids have been exclusively breastmilk fed (I work out of the home, so they get expressed BM after 12w), and we have/are currently extended breastfeeding.

My personal perspective is that there is not enough support for new moms postpartum to make exclusively breastfeeding a stress-free experience for women. And, unless and until there is that support (LOLZ USA), then yes, we need to go with a "fed is best" approach. It's simply unfair and mean to place the expectation of breastfeeding exclusively on women without the proper support, and we have so far to go in that regard.

[saz]

I struggle with the "we need more support for moms so breastfeeding is easier!!!!!!" It doesn't do anything about the fact that for a lot of women, pumping fucking sucks. Then there are people like me who were able to breastfeed easily without any problems but absolutely hated it. In the pro-breastfeeding world there is an assumption that everyone wants to do it and loves it but I didn't. It wasn't hard for me, I just completely hated it. There was no "choice" for me and there would have been no support, just shame, for me if I did choose formula. That's just plain wrong.