Dear all:

I really have to say that I am stupefied by someone who claims that marketing of bottles 
does not make a difference.  I just recently gave a talk at Cornell in December and 
unfortunately did not get to the bottle part --- but I did take pictures of about one third of 
the bottles in Buy Buy Baby before they freaked out and so did I because, apparently, you 
are not allowed to take pictures in stores.  Not even Barnes and Nobles will allow you to 
take pictures in their stores without filling out tons of paperwork to the head corporate 
office and waiting weeks for approval.

Even before I looked at the marketing of bottles in Buy Buy Baby and other such stores, I 
knew that marketing was making a huge difference in choices. The following are the 
order in which the marketing seems to influence parents in my clientele

1) The most expensive bottles were being picked by parents because of the big fat 
usually red star or yellow star label of BPA free. That is what really works most currently 
in the Manhattan environment.  
2) Of course, "clinically proven to prevent colic" was written on most bottles as well.  I 
looked up their claims on some of the websites that actually provided THEIR research. It 
did not consist of any clinical definition of colic, merely a selected set of their own 
criteria of fussiness where they compared their bottle to someone other company's bottle.  
It was not by any stretch of the imagination peer-reviewed research.  
3) Then there was a whole array of bottles that advertised some new gadget to reduce 
gas --- which sometimes overlapped with 2) above.  These included drop-in liners, valves 
or filter system that supposedly reduced air, inserts that supposedly slowed the flow -- 
including second nipples, and flow rates.
4) Next was "shaped just like the breast".  There are nipples that are squared off at the 
end -- with a sharp edge, so called "orthodontic nipples" that are pinched in ways that no 
woman in her right might would want her nipples to look like, what I call the cliffhanger 
nipples where the base of the bottle sharply drops to a little skinny nipple and even 
nipples that are surrounded by an indented donut and then the fat base.  All are 
advertised as just like the breast.  Now, I always tell parents to ignore that and just look 
at the shape and think how it might feel if a nipple where shaped the same way as 
whatever it is they plan to stick in the baby's mouth.  I have a particular peeve about 
"orthodontic nipples which have been labeled "squash and floods" by the speech and 
occupational therapists.  They are very fast flow and actually distort the suck swallow 
patterns and interfere with palate development.  I call them "antiorthodontic".  
Unfortunately, parents select "orthodontic" pacifiers because of the little ring so they can 
clip it to the baby's clothes and because the "orthodontic" pacifiers are harder for a baby 
to spit out or drop.  
5) The final labeling that drives me nuts is the labeling of flow rates by baby's age.  This 
is designed to fool parents into buying more nipples and thinking that it is healthy for 
their baby to "develop" into guzzling down their food faster.  Now, think of all the eating 
disorders we see in the United States.  In watching baby's eat, I think the forced rapid 
feed has a lot to do with setting up abnormal feeding patterns.  But mothers will buy the 
next age range of nipple for their baby because they want to think their baby is 
progressing.

Over the course of the last four or five years, I've noticed that this advertising has 
pushed parents to select bottles that are NOT ONLY WORSE FOR BREASTFEEDING, BUT 
WORSE FOR BABIES GENERALLY.  Yes, even if I were to teach all the formula feeding 
mothers in Manhattan, I would still be just as pissed off at the misleading advertising. 
These mothers and babies really get short shrift from a whole variety of sources to teach 
them ways of feeding and choices of feeding devices that put babies at higher risk of 
choking, aspirating, overfeeding, and aggravation of regurgitation to the point that it 
becomes diagnosed as reflux.  

Personally, I still prefer the cheapest bottle out there for most babies that may need an 
alternative feeding device over the expensive brands.

Now, Lisa Sandori and Karen Gromada did an excellent study of flow rates.  Its not 
perfect, but very good.  It didn't cover all the bottles, but it covered a lot of them. When I 
looked at their analysis and separated out a graph of their "hospital" bottles and the 
bottles parents buy --- a very interesting pattern emerged.  The "hospital" bottles are not 
purchased by hospitals according to the safest bottles for newborn infants, they are 
"PROMOTIONAL MARKETING SAMPLES".  Guess which bottles were on the very rapid flow 
end of the spectrum?  The PROMOTIONAL MARKETING SAMPLES given out by hospitals.  
The ones in the stores did overlap with these promotional samples but the range was 
much wider and you could find bottles with a flow that was closer to breastfeeding.

What does this tell you about the benign effect of promotional samples and marketing?  
Do you really think that the companies that planted these nipples in hospitals were naive 
to the impact that the rapid flow would have on breastfeeding?

Now, guess where the Medela nipples are on the spectrum of flow rates?  And until 
recently their nipples were the antiorthodontic squash and floods.  Now some have a 
slightly better shape but they are very rapid.

Furthermore, I am about to rip my hair out today because of the 11th, yes 11th woman 
who has had a problem with her supply when SHE REALLY REALLY DID NEED TO PUMP 
because of the marketing of the FREE-STYLE Pump as better.  Time after time I am 
finding that their supplies are in the toilet and immediately improve when they switch 
over to an industrial grade pump.  Time after time I've seen mothers with the Free-Style 
pumps that have not been suctioning to specifications and the women have to send them 
back to Medela.  The woman today had sent the pump back so many times that she had 
barely been able to pump in the first critical two weeks when her baby wasn't able to 
attach to the breast.  HOW CAN YOU CLAIM THAT THIS HELPS MOTHERS?  It is totally 
irresponsible advertising.   These women had to work much harder to rebuild their supply 
because of bad advertising, not because they were not fully willing and able to do the 
right thing to get their babies on the breast.

The worse case was when Baby's R Us told the parents that they should send the Free 
Style pump to Realbirth --- a completely independent distributor that does childbirth 
education and postnatal classes for women to "FIX THE PUMP".  That would be like 
someone buying an expensive dress at Saks Fifth Avenue that fell apart only to be told to 
take it back to Macy's to have Macy's tailor fix the dress.  I have yet to meet a single 
mother who can actually use those straps to pump hands free.  

And what about all the PROMOTIONAL SAMPLES OF PUMP equipment in the hospital?  
Those pump parts do NOT work as well as the parts that women purchase.  I have also 
seen women sent home with those so-called "free" pump parts that women are actually 
paying for when they buy Medela products and cover Medela's marketing costs.  They do 
NOT work as well.  Time after time I have seen how those slightly narrower openings in 
the promotional breast shields cause more pain and the slightly narrower tubes cause 
more pain.  Then because Medela has given them those parts they have to buy another 
whole set of parts when they come home including the tube because by then they have 
purchased a Medela pump or rented one. Had their not been a "MONOPOLY" of 
"PROMOTIONAL SAMPLES" from one SINGLE company they would have had the 
opportunity of choice of selecting the most functional means of expressing milk that 
worked for them, rather than being sent down a path of having to replace inferior 
equipment designed to promote a product.

Monopolies are not good for development of better equipment.  They are especially bad 
when it comes to health care.  

I am completely fed up today with bad advertising and having to mop up after the 
consequences of bad advertising. 

Sincerely,

Susan E. Burger

PS.  One store that sells Medela products in Manhattan actually told the rep to her face 
what she thought about the bottle nipples in a way that I can't repeat on Lactnet.  While I 
would not have chosen that word, I have to agree with the sentiment.

Oh -- the new advertising that is really killing me on bottles is that they are somehow 
"green".  Some of these bottles are really rock bottom in the feeding department and I 
fail to understand how any bottle can be labeled "green".  

             ***********************************************

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