Sarah

These discussions seem to be becoming a little uncomfortable.  As an 
observer, it seems to me that you're having to defend yourself  and 
the feeding choices you made for your daughter (to feed her formula 
when you returned to work) a little too hard.  Why should this be 
so?  On the one hand, this was your daughter, your career and your 
way of working through your baby's refusal of stored breastmilk in 
the way that you thought would work out best in your individual 
family circumstances.  On the other hand, LACTNET subscribers are 
mostly LCs, and although one of our duties is to support a mother 
where she's at - had you been one of our clients this discussion 
would no doubt have taken a very different turn - underpinning our 
support for mothers, most LCs see themselves as having an obligation 
to speak for the end-user of the mother's infant feeding choice - 
that is, the baby.  And I think you're asking us - as colleagues on 
LACTNET, not as your personal LCs - to agree with the rightness of 
the choice you made to feed your daughter formula a little before the 
age of 6 months on the grounds that there was unlikely to be a 
significant problem, and you seem to ask for recognition that there 
are a vast variety of different circumstances across families and 
that no single simplistic rule (against offering formula) can cover them all.

It might be that we cannot endorse your choice because we are 
schooled in the WHO recommendations for infant feeding, ie exclusive 
breastfeeding for the first six months of life and continued 
breastfeeding with the addition of appropriate weaning foods for up 
to two years or beyond.   WHO give the first choice as breastfeeding 
by the baby's mother.  If the baby can't be breastfed, then the next 
best option is the mother's own expressed breastmilk, followed by the 
expressed milk of another mother, and only if none of these are 
available is the recommendation made for the baby to receive 
formula.   There are no circumstances where formula could be 
described as a preferable choice, unless the first three options were 
absolutely unavailable.

And we would probably be constrained to point out the difference 
between choice and capacity, ie between the mother who physically was 
not able to breastfeed or breastmilk-feed due to physical/anatomical 
difficulties, and the mother who chooses to disrupt breastfeeding in 
order to return to work to fulfil family/societal/financial 
commitments or ambitions.   It is not the LC's job to give permission 
for formula-feeding when a mother finds herself unable to meet other 
commitments and breastfeed simultaneously - rather it is the LC's job 
to provide the mother with enough information so that she is aware of 
the impact that substitutes for breastfeeding, and particularly cow's 
milk-based substitutes, are likely to have on her baby's immediate 
and future health/well-being/development.  The differences between 
infant formula and human milk are not trivial.  While we might accord 
the individual mother the absolute right to make her own infant 
feeding decisions based on what she knows will work best for her, 
when we're talking about general recommendations for the majority of 
mothers and babies, we're duty-bound to endorse global, 
evidence-based guidance.  It's only in vastly privileged societies 
that the individual choice to formula-feed can be elevated above the 
public health imperative of breastfeeding without serious harm 
befalling the baby.  Somehow this luxury has been co-opted by 
feminist discourse into a universal right which seems often to 
supercede the baby's best interests.  But that's another matter.

Meanwhile, Sarah, I think it's the tension between the response to 
your individual experience, and the general guidance/protocols/ that 
IBCLCs would normally be voicing, that you're feeling.   I don't 
think you'll be able to persuade us into a different point of view on 
this one!   Although I may only be speaking for myself, of course ...

Pamela Morrison IBCLC
Rustington, England
----------------------------------------

Sarah wrote,
decisions are made not purely on health risks and
benefits but on other factors as well. There are many possible
circumstances where the benefits of donor milk vs. formula might be
small enough and the practical difficulties large enough that formula
would come out as the preferable choice overall *for that family in that
circumstance*.
.... I truly can't think of any likely or significant problems
with giving formula in such a situation. (I suppose there's always some
rare potential risk someone could point to, but then the same is true of
milk obtained through informal milk-sharing networks.) Not asking this
to be in any way argumentative or defensive, but genuinely curious as to
where you're coming from on this!

....The reason I went back to work was because,
due to our particular circumstances, it worked out considerably better
for my husband to be the one who took the career break to be the SAHP.
I don't use my experience to 'applaud formula'; I use it to recognise
that there are a vast variety of different circumstances across families
and that no single simplistic rule can cover them all.

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