Cindi states:

>But that *can't* be the issue for a HCP.  The HCP has to decide whether
formula can cause >harm.  If they decide it does (and oodles of research
supports this decision), then they ethically >cannot give it out.

I usually try to stay out of the political realm on most of the
breastfeeding stuff on Lactnet since I have very strong political feelings
that often are at odds with what I see from others in the Lactation
Community.  I have not yet decided how I feel about the ramifications of the
Texas law since I have not yet considered all of the possibilities.  

However, I really feel concerned about the line of thinking that I am
starting to see on this.

Obviously, I do agree that there is a ton of research stating that formula
can cause harm.  
More obviously babies who do not get their own mother's milk should get
human milk from another source.  Unfortunately, this is not reality in the
US today.  

Keep in mind, HCPs often recommend treatments or medications (or formula)
that can cause harm.  For example, the underlying idea of chemotherapy is
poison the patient enough to kill the cancer without killing the patient.
We do not withhold chemotherapy in patients with cancer.  Many drugs have
significant side effects but they are still needed for a particular
indication because the risk of the disease is greater than the risk of the
medication.  We ask:  What is the relative risk of the treatment?  

Is the risk of formula or the risk of immediate malnourishment greater?  I
suspect that most of us on this list run across scenarios where baby needs
calories; donor milk or mother's own milk is unavailable or insufficient.
We are left with either suggesting that the baby not get fed or use an
alternative.  This is usually formula in the US.  I would LOVE to be able to
say to a mom who has a baby who needs more calories, go to the local milk
bank and pick up some extra milk for baby.  Until this is a reality, the
risk of not feeding baby is often greater than the risk of formula.

Suzanne's scenario of an 8 month baby who is undernourished is actually one
of the things that need to be considered.  Many good ideas have unintended
consequences.  This might be one of those unintended consequences.  Melissa
Vance talked about an LLL website for Proposed Legislation.  Perhaps some of
the legal minds on this list, with brainstorming from the rest of us, could
put together some sort of model legislation that would be sensitive to the
immediate needs of individuals without loosing the perspective of how it
affects our society.

I hope this post makes sense.  If we scare parents about formula, what will
they feed instead if they are not breastfeeding?  We need to find a way for
parents to know the risks of not breastfeeding.  We need to find a way for
babies to get the human milk that they are entitled to.  We are the ones who
should do it.  We all are passionate about this and have the best interests
of babies in our minds.

Please keep up the discussion, perhaps something will come of it.

Linda Pohl, IBCLC
Phoenix, Arizona, USA

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