Dear all:

Pretty much every aspect of potential counseling for mothers is already covered under the International Code on Marketing of Breast-Milk Substitutes.  If baby friendly policies were to be enacted, there would be no need for the study that actually gave supplementation before it was needed.

First, if we didn't have 95% of US hospitals having baby unfriendly policies:

a) Far more mothers would be able to hold their babies and put them to their breasts frequently
b) As a result of a) far more babies would be stimulating the milk supply
c) As a result of b) far fewer mothers would encounter iatrogenically-induced low supply
d) As a result of c) far fewer mothers would end up with babies who desperately cluster feed once they wake up to the fact that they need to eat more than their mothers are producing once mothers are at home and the baby needs more than the 22-27 ml that they should consume around the time they leave the hospital
e) As a result of d) far fewer mothers would feel they need to use formula
f) As a result of all of the above babies would gain more weight and mothers would actually get more sleep because they have been doing everything they can to "sooth" their babies when they really needed to eat.

And for those mothers who do have problems:
a) Far fewer mothers would need to use a breast-milk substitute because they would have been shown how to hand express
b) Mothers who had to use a breast-milk substitute would be provided INDIVIDUALIZED counseling which would include:
i) full information about balancing the risks of the various options -- including how to weed through the misleading advertising (e.g. debunking the notion that soy doesn't cause allergies and that powdered formula is sterile) 
ii) shown how to prepare that substitute properly
iii) shown how to feed that substitute in ways that would reduce the risks of overfeeding
iv) shown how to encourage bonding through some breastfeeding and/or skin to skin contact

And yes, we already have the option of individualized counseling for mothers who have no problems whatsoever but still want to formula feed. That is already part of fully informed consent.

With 95% of the hospitals having baby unfriendly practices already -- what we don't need is to encourage mothers from the get go to give extra formula when their baby is not at risk and when there are plenty of better interventions that are really not that hard to implement.  

As for the gut health issues -- there is now no continent left untouched with increasing problems with obesity and there is an increasing body of evidence that gut health plays a role.  Since obesity is clearly a multicausal problem, why aren't we throwing everything we have at this problem.

Quite frankly, I find this whole discussion demeaning to health care practitioners.  The notion that simply offering formula rather than doing counselings has the implicit notion that it is just too difficult to talk to patients about real health issues and help them make informed decisions.  Its just some much easier to crack open that bottle at the 5% mark and spare yourself all that extra counseling.  And since we already have destroyed the full support for breastfeeding anyway -- to the point that 95% of our hospitals have policies that interfere with it -- why bother to fix it.

Best regards,
Susan E. Burger.

PS -- About 90% of my clients have had their babies supplemented with formula before I see them.  The vast majority of those did not need it -- some did.  Sometimes I am the one who has had to suggest calling the pediatrician for approval to use it.  Among that 90% I have countless examples of when formula was given to the infant without consent of either the parents or the pediatrician.  To date, I have NEVER EVER seen one parent who was prevented from giving formula to their baby.  I think this is a totally false debate.

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