Jessica Harrison Carlyon asked, "Any suggestions as to what the polite yet
proactive thing to do would be?"

Dear Jessica,

Congratulations on the birth of your third baby.  (As a #3 myself, let me
encourage you not to forget to take lots of pictures!)

Here is my take on how you might react after this hospital, that you say did
quite well with bf promotion and support, handed you a formula marketing bag
as you were going out the door.

1. You are that rare person: a well-informed and empowered consumer.  Use
that status!  This hospital practice exposes hundreds of other mothers to
risk, but they don't know it.  You are speaking on their behalf as well as
your own.

2. Writing a letter sounds like something you can do with the time and
resources you have available, even as a mother of three with a newborn
nursing baby.

3. Figure out whom to send the letter to.  I think it should go to everyone:
nurse manager of Maternity , and the administrator who runs the whole
maternal-child department; the lactation staff; the maternal-child patient
education department; the Chiefs of Pediatrics, Family Medicine, and OB; the
hospital ethics person or committee; the public relations department; someone
in the financial department; and the CEO.  Put the whole list of people who
are getting copies into the letter.  You can probably find out the names of
these people by making a couple of phone calls.  If you have a friend on the
staff, ask her to ask around or consult the hospital directory for you.

4. There is lots to praise about the breastfeeding program at this hospital.
Mention those things in detail in your letter...but briefly.

5. Document the details about the formula bag--maybe a photograph of the
contents?  Quote any advice it contains that would undermine breastfeeding,
especially for an uninformed and inexperienced mother.  List the coupons,
samples, etc...maybe calculate how many ounces of the stuff a mother can get
if she uses everything in the bag.  This could go on a separate page if your
letter is getting too long.  You want the letter itself to be one page--no
more!

6. Then say something about the message that the bag sends to a new mother
and how that message undermines the good work that everyone else is doing to
help women succeed at breastfeeding.  You could quote research if you wanted
to, or mention briefly that such research exists.  Or you could make a point
about inefficiency: why pay LCs to teach people how to breastfeed and then
hand out materials that tempt families not to follow what the LCs have told
them to do?

7. End with a sincere comment about your disappointment or puzzlement or
anger--whatever it is that you are feeling because of the mixed message the
hospital sends.

8. Ask for a response of some kind.  Maybe you could ask why they have chosen
to send a mixed message about infant feeding.  Or ask to see the part of
their breastfeeding policy that justifies giving formula marketing materials
to breastfeeding mothers.

My ideas here are these:
Somebody quite high up makes the decision to accept the goodies from the
formula company.  It is probably a financial decision.  Do those people even
know what is in the bag? Do they even think about the message it gives to
mothers?

Hospitals want to operate ethically and have good relations with the public
so people will come and buy their services.  But the ethicist is busy with
life-and-death decisions, and probably does not get consulted on questions of
whether to let commercial interests undermine good health decisions by
consumers/customers.

The usual arrangement is for a hospital to get its formula free, and maybe
some other products too (either free or at discounted prices), in return for
marketing the formula by giving out the bags.  Often there is a cash bonus on
the side, too.  The financial people probably think this is a good deal for
the hospital.  This is your chance to point out the "downside" of the
deal...the detrimental effect on women's ability to make and carry out the
decision to breastfeed exclusively for six months...which after all is what
the AAP, ACOG, and AAFP recommend.  As someone who has been affected by this
financial decision, you are perfectly placed to explain its potential to do
harm, in a way that a breastfeeding-friendly staff person inside the hospital
system might not be able to do because of in-hospital politics.  You have
more power, in a way, than the insider, because you (the consumer) are the
person they must have in order to make their whole system operate.

By copying to all those people and asking for a response, I hope the effect
would be to get them talking together about why they do this.  The people who
know why it is NOT a good idea to market formula through the hospital might
actually get to talk to the people who make the decisions.  In fact, getting
a copy of your letter allows them to ask the people with power, "What are we
doing about that letter we got about the formula discharge packs?"  As
someone who worked in a hospital for 19 years, even ran an in-hospital
breastfeeding center for four of those years, I would have LOVED to see a
letter like this come through the mail slot!  I wrote policies, I complained
about the discharge packs...but I never had the ear of anyone who signed the
deals with the formula company, and we handed out those *!@#* DC packs every
day of my 19 years...as they are still doing, I am sure!

Depending on the answer the hospital sends you, you can decide what you want
to do next.  There's always the Press....but there's always just settling
back in the rocking chair, knowing that you did your part in the struggle.

Keep us posted.

Chris Mulford, RN, IBCLC
Swarthmore  PA---eastern USA

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