Ban Formula in Hospital Gift Bags?

Should hospitals encourage breastfeeding by curbing distribution of those Similac or Enfamil freebie goodie bags they give away in the hospitals?  Apparently, "Portland is the first city in the nation to have both public and private hospitals ban the formula sample packs", according to the site BantheBags.org.  The O reports: A recent article in the American Journal of Public Health cites one of our epidemiologists saying that hospitals shouldn't be giving out free formula when new moms are discharged from the hospital.  It discourages breastfeeding.

Should we ban the bags (of formula)?  If not formula, then what goodies would you consider appropriate to send home with new mamas from the hospitals with their newborns?  Did you get a goodie pack?  Did you use all the stuff inside?

Comments

[KMat]

I guess we are assuming that a woman who just gave birth is incapable of making informed decisions about how to feed her baby. I mean, really, is this such a big deal? I got some cheesy diaper bag filled with formula, coupons for newborn pics, some diapers...I didn't use the diaper bag (too plastic-y), I saved the formula "just in case" but ended up giving it to a friend after a month or so, totally did not go in for those horrible pics of the wrinkly baby in the hospital bassinet, and used the diapers in my own diaper bag when we were traveling. I think there was even a pacifier, which I also didn't use. Of all things to get worked up about...

[lauralye]

Even though I breastfed all three of my kids--still nursing the two-year-old--I was grateful to receive formula samples in the hospital: My first child used the formula at about two months, so I could get more than 2 hours of sleep at a time. My second child was required to have formula initially due to low blood sugar levels at birth, and my third never took to it, so I gave it away to a friend who had to return to work. She tried breastfeeding, but having to travel to China for two weeks on business compromised her efforts.

I know some purists are against any formula, but supplementing on occasion did not compromise breatfeeding at all in my case, and it helped me get through some rough spots.

[abby]

I have mixed feelings on this one. On the one hand, I think it's pretty darned inappropriate for a hospital to push products on people, essentially offering free advertising. The drug samples are bad enough -- and totally inevitable -- but there are already so many people telling new parents all the things they need to buy, and I think it's pretty offensive to have that stuff coming out of the hospital.

I think it would be a step in the right direction to at least have those goodie bags handed out in conjunction with a session with the hospital's lactation consultants. At least then it would be coming with some information.

On the other hand, there are situations where formula is appropriate, and I think it's fine for the hospital to be able to hand it out where it is appropriate. My daughter received a wee bit of formula in the hospital, as she was under 5 pounds and my milk took a bit to come in. One of the nurses used a case of formula to tell us she loved us as she sent us home, and though we never used any of the stuff, it was a very sweet gesture. We donated it to Insights Teen Parents center, and I hope that it went to someone who could use it.

Like the previous posters said, I think we need to trust and respect women enough to make an informed decision on breast feeding, provide information when it is lacking, and bless each family whatever they end up deciding. Life is way too complicated for one thing to work for everyone.

[LTF]

I agree with what Abby said that life is far too complicated to have any one policy be right for everyone. And while there are clearly loads of other issues to get wound up about, everyone has theirs, and this is that for some. In my mind this has nothing to do with whether women are ultimately breastfeeding or not (personal choice! different circumstances!), but with helping us to start off in the direction that is proven to be healthy for kids and moms in many ways.

The question I have is why are the formula companies providing free formula to new moms? I think the answer is pretty obvious. Hospitals can make free formula (many brands) available for moms to ask for if they go home and need it. Then again, is that all that different? Perhaps in my mind it is a symbol of formula manufacturers trying to get moms to use formula - specifically their brand - because they make money from every new customer. And I object to that end of it - which is not to say that should necessarily dictate the new mom angle. I know that establishing breastfeeding as a first-tiem mom can be tough, frustrating, tiring, & painful.

I was glad to have soem serious support in the hosp (Kaiser Sunnyside) to make it work. it's a vulnerable time, and I wonder if making it available makes it that much easier to use it when maybe that mom doesn't need it or want it? In the end, though, i confess to being one of those people who has enough decisions to make about my own life that I find it far easier to let others make their own personal decisions. i am glad no-one gave me any :-)

[Jillian]

Since my baby would not be alive today without formula, I'm not in favor of any type of ban...we ended up being grateful for the free samples. There's way too much hype around breastfeeding...I think breastfeeding's awesome, I think it's healthy and rightly preferred, but please let's be realistic about how many moms are able to breastfeed (both time-wise and physically) and how many babies need formula supplementation for whatever reason. I'm so thankful that an alternative to breastmilk exists, and gives me a happy, healthy alive baby.

Being a mom that formula feeds, I'm tired of explaining myself why I give formula, and I'm tired of the stigma and judgement. All I ask of everybody, from hopsitals to breastfeeding moms, is please please let's be realistic about breastfeeding and also give moms freedom of choice. (I love what the first poster said..."I guess we are assuming that a woman who just gave birth is incapable of making informed decisions about how to feed her baby")

[Becky]

Jillian - I am sorry that you get that kind of reaction to using formula. I got the same reaction to mostly nursing only, especially from my mother-in-law. She only used formula for her children b/c she didn't really produce any milk of her own. I think that its great that there is formula for those who need to or choose to use it. It has saved a lot of babies that might have otherwise not survived. I just choose to use breast milk instead b/c I have SOOO much of it and its free and always on hand.
I think that if you are given samples of formula, or pacifiers or whatever from the hospital, you should take them and pass them on to someone else who might use them if you choose not to. After all, having a baby isn't cheap and you might be paying for more of those "free" things that you think.

[shetha]

My concern with the free bags was always the marketing aspect of it. It irritated me that the formula companies were competing with each other for my attention and the hospital was aiding and abetting these practices. I think my argument isn't that different from what folks above have stated. I would like to be free to make my own decision (about which formula to use, if necessary), and while I'm in the hospital perhaps a medical expert can consult on what the best choices are (without some bias based on which pharma company was just visiting and buying them lunch that day). I guess maybe I'm living in some fantasy land in my little head. That said, I still use the free bags. I'm a bag freak though... the more bags the better.

[Jillian]

I understand concerns about the marketing aspect. My concern is that banning the free samples just sends another negative message about formula feeding...and in my experience there's already way too much stigma around it. And for those that have to, for whatever reason, use formula, free samples are a very good thing.

In my mind, it's a lot like banning C-sections or epidurals from hospitals because natural childbirth is better. Or eliminating the hospital nursery because co-sleeping is sometimes preferred. I feel until there's more realistic, balanced information out there about the positive aspects of formula feeding, the message they're sending by banning formula samples isn't a good one.

[anon.2]

You'll have to forgive my ignorance, but don't all the area hospitals send lactation counselors around to new moms after babe has been born? My memories of the experience are foggy but I would swear that at Sunnyside [where I birthed], as well as at Emmanuel Legacy and SW WA Med Center [where friends have had babes] the lactation counselor was an absolute part of the post-birth check-in. So do folks not think that "balances out" the formula freebies?

And if not, what's the answer, given that there are other respondents here who feel strongly that formula giveaways are helpful for some new moms? Seems like breastfeeding classes & support for pregnant moms [ie, pre-birth] are at the option of the mom only... But I'm not sure how I'd feel about making those "mandatory" for all moms.

[sarah]

so maybe the hospitals could have their free supplies available for those who need it instead of handing it out. i think there is definitely an element of "breast is best" in this argument to ban (and i dont think most people would disagree with breastmilk being best for baby based on science, recommendations of the world health organization, etc). now ofcourse formula exists to feed baby when that's all there is. even the breast zealots understand this is the way sometimes (right?!) but in my opinion it's also about the education of it... when doctors, hospitals, etc give out supplies or concepts, those are accepted by most people. parenting (especially having just given birth!) puts us in an extremely vulnerable situation - we want to do right by baby. always. but for example, it takes about three days for the milk to "come in". three days - this is the way the body works. baby is nursing (takes about three days to contract the uterus back into shape...) and receiving that golden elixir, colostrum. is it standard for women in hospitals to be given formula to "supplement" during this time?

[Jillian]

It is definitely a vulnerable time period for new moms, and I see where you're coming from about the downside of handing out formula. What I'd like to see is a freedom of choice...you can always turn down the free samples. Formula is really expensive, and for those who need it free is a really good price.

I think education and allowing moms the freedom to choose are both key.

[Becky]

You know I don't remember ever being offered formula or a pacifier or even to take our girl away to the nursery for us. I delivered her at Emanuel Hospital and the only time that said that we couldn't go with her was when so got all of her very first vaccination, I don't remember what it's called, and they only gave her a pacifier with a little medicine just that once. I wonder if it was because I already had my mind made up about a few things. I did not want to use pacifiers at all and as long as I could get her to latch on I was going to do my best to breast feed. Obviously if this wasn't an option I would have been using formula. I agree with the freedom of choice and education statement. I think that people SHOULD do their homework before they go to the hospital: if you don't want formula, unless that is the last possible option, make sure that your support knows that too. If you don't have a preference than let them know that too. Its your body and your babies body and you need to make the best choices for both of you. And if anyone else has a problem with it, it's their problem!

[catmom]

As an adoptive parent, I've got a few thoughts.

I'm pretty sure the manufacturers have two reasons to give you samples at the beginning. One is that if there are bumps on the road to breastfeeding, they see it as an easy opportunity to jump in and grab you as a new customer. Obviously, the trouble with this is that some women who persist can go on to breastfeed successfully. If they fall back on formula then their milk supply can nosedive, and formula becomes the only choice.
Breastfeeding advocates naturally want to reduce the temptation. But the other side of this is that withholding samples and information in order to set up hurdles on the path to formula is a bit coercive - in some countries now, you're not allowed to buy formula without a prescription from your doctor.

The second reason is that, as it turns out, babies adapt to digesting a certain brand of formula. We used Similac because that's what they fed her during her days in the hospital. Later, we tried to switch to Costco's Kirkland brand, and she became constipated in an instant. I suspect if we'd used Kirkland from the get go, it would have been fine, but because she started on Similac, it became our only choice. I wish we'd known things like that from the beginning - in Portland, information about formula feeding didn't seem that readily available, partly because every single one of my mama friends breastfeeds.

I believe in breastfeeding because it is the best nutrition possible for a child. (If anyone believes that bottle feeding is bad for bonding, please give that some more thought, and perhaps read Ellyn Satter's Child of Mine: Feeding with Love and Good Sense)
I believe women should be able to do it anyplace without dealing with any crap from any one. But I become frustrated with people who think that attacking formula - and eliminating choice - is the surest route to promoting breastfeeding.

If our government were serious about improving the rate of six month and one year breastfeeding rates, it would give women long paid maternity leaves. In a place like Portland, that offers good lactation help to most women, separation from an infant and trouble pumping (along with nasty anti-breastfeeding attitudes in some places) seem to be the biggest obstacles.

[Amy]

I agree firmly with the first comment. Trust mothers to make their own informed decisions. Withholding assistance or information of any kind is not the way. Yes, the formula companies are looking to gain a customer, but I'm sure that if there were information about lactation clinics tucked inside that bag, it'd be because the clinics are looking for paying customers (as well as doing their good work). Breastfeeding might be best, but formula feeding is second best and an essential component in the arsenal if things go well.

Jillian, you aren't alone feeling ostracized in Portland as a formula-feeding mom. I barely left my house for six months, for fear of being seen with a bottle and getting the nasty glances or the downright invasive third degree. It was devastating the breastfeeding didn't work out in my circumstances - and you better believe I agonized over my formula brand choices - no freebies from the hospital would have changed that, but I might have felt a hint more support.

[Amy]

Oops, sorry, that should have said, "... if things don't go well [with breastfeeding]."

[Tony at Milagros]

I think it is beneficial to review the information contained in the journal article that is referenced in the original post.

I am not a APHA member nor do I want to be but anyone can view the article abstract for free:

http://www.ajph.org/cgi/content/abstract/98/2/290

The bottom line is that the researchers observed a statistically significant correlation between breastfeeding duration and the receipt of a "discharge pack". Mothers who received a discharge pack were less like to breastfeed exclusively past 10 weeks.

It is important to note that the population being measured here isn't all mothers but mothers who initiated breastfeeding while in the hospital. At least at discharge, these were not mothers who required supplemental assistance for feeding their infants.

Based on this analysis, the author concludes that "Commercial hospital discharge pack distribution should be reconsidered in light of its negative impact on exclusive breastfeeding."

Since this is a peer-reviewed article, I would be greatly surprised if controls on other factors that may influence breastfeeding choices (socio-economic, etc.) were not made as part of this statistical analysis.

I don't think anyone can argue that formula shouldn't ever be used. There are plenty of examples in posts all over urbanmamas where its use has been absolutely necessary. Moreover, all parents have the right to choose between breastfeeding, formula, or some combination based on their own needs. For the record, my family is in the exclusive-breastfeeding camp on the choice issue.

However given the results of this study, unless a mother is in the hospital and has a immediate medical necessary use for formula or specifically requests it for any other reason, I don't see any compelling reason for hospitals to provide formula samples to new mothers at discharge. For whatever reason, just receiving the sample influences a choice away from breastfeeding. Perhaps this is because its distribution by the hospital implies an endorsement or recommendation for its use (who know?).

Putting the formula question aside, is it ever really appropriate for hospitals (or any health care professionals) to assist with promoting or marketing ANY non-medically necessary product to their patients?

I don't think so.

[Jillian]

One aspect of scientific studies, especially in relation to women's health and parenting, is that they often don't take into account socio-economic realities for many women. Also, such studies tend to reflect the political, economic, and/or social climate of the time....which is why science used to say bottle was best, and in 10 years time may well say something different. What I would like to see instead is a population analysis of why women aren't breastfeeding, and then have those basic issues addressed (like a previous post suggested). There are medical reasons for not breastfeeding that could be further studied, as well as soci-economic reasons. Perhaps with the results of those studies, something could done to help women where the essential problem exists (poverty, lack of decent breast pumping facilities at work, medical mysteries yet to be studied) rather than having a blanket ban on free samples which takes away a small benefit for some women as well as adds to the feeling of stigmatization.

Saying that the pages of this and other websites are covered with the formula vs. breastfeeding debate I feel does nothing but shut the discussion down. Unless I can be pointed to an area where the debate has been solved (where both sides of the breastfeeding issue feel listened to and unstigmatized), I'm happy to continue the discussion.

Also, I doubt that women's basic breastfeeding philosophies are so fragile as to be influenced by free samples. But if they are, perhaps we need something to help women more. Perhaps something similar to one being enacted in a Michigan county, where free postpartum nursing visits are offered in the home (paid for by the county). A nurse comes in and does several well-baby checks during the first several weeks, and follow up visits if necessary. If that service could be expanded to a federal level and include lactation consult services (and yes, formula advice, because sometimes it is necessary), then the whole issue of free formula samples in the hospital becomes a non-issue.

Lastly, it's important to note that formula in some cases is medically necessary (it was prescribed by my child's doctor, and I was given a medical insurance code that reflected that necessity).

I think freedom of choice on this issue, allowing women to decide for themselves, and becoming educated on the realities of breastfeeding and formula feeding is key.

[catmom]

It would be easier to know the impact of this study if it looked at the difference between those who were offered or not offered formula, rather than the difference between those who received or did not receive it. Logically, the group that did not "receive" formula would include women who declined the offer, probably because they were already deeply committed to breastfeeding or already realized it was going well for them. The group that did "receive" formula probably included mothers in my situation who didn't have a choice. This skews the result. I assume the researchers who wrote this analysis were stuck dealing with the "received/not received" question not because they are biased, because this is the way the question was asked seven years ago on the "2000 and 2001 Oregon Pregnancy Risk Assessment Monitoring System."

[catmom]

Also: "Putting the formula question aside, is it ever really appropriate for hospitals (or any health care professionals) to assist with promoting or marketing ANY non-medically necessary product to their patients?
I don't think so."
For my child, formula has been medically necessary. It kept her from being dead. Perhaps someone in the hospital is all-knowing and can foresee for whom this will be true. That person could offer formula only to the women who are going to have real trouble with breastfeeding and won't have lactation support, or only to those who will be in a car accident or have a stroke or some other emergency that separates them from their infants. Those people would be allowed to have an emergency can in their cupboard, and information that tells them which kind to use and how to prepare it.

[Tony at Milagros]

When I said...

"Putting the formula question aside, is it ever really appropriate for hospitals (or any health care professionals) to assist with promoting or marketing ANY non-medically necessary product to their patients? I don't think so."

The non-medically necessary products I was speaking to were the plethora of promotions for other products contained in those types of bags - photo offers, diapers, baby food coupons, and so forth. I was not talking about formula.

By beginning that sentence with "Putting the formula question aside," I thought that I was making this distinction clear but I can accept that it was not clear enough.

I would never say, imply, or suggest that formula is not sometimes medically necessary - I believe its practical use is indisputable. I am sorry about any confusion in this regard.

That said, I don't want this clarification to undermine my personal opinion on the question in the original post.

This is my opinion and response to the question "Should we ban the bags (of formula)?" :

1) I think that hospitals should offer formula samples to their patients who are unable to initiate breastfeeding, have some other medical necessity for its part time or full time use, or explicitly make the choice to forgo breastfeeding for whatever reason.

2) But other than the situations I just mentioned above, I do not see any compelling reason for hospitals to provide formula samples at discharge.

The American Medical Association and American Pediatrics Association recommend exclusive breastfeeding for the first six months of life. They also recommend that no supplements (water, glucose water, formula, and so forth) should be given to breastfeeding newborns unless a medical indication exists.

For hospitals to provide formula to those who do not need it or request it seems to send a mixed message on what is the recommendation of heath care professionals in this regard.

The study referenced in the original post concludes that the effect of this mixed message may be influencing mothers away from the practices recommended by the AMA and APA.

3) Do I think that "banning the bag" is the only health policy on this issue that should be adopted? Absolutely not, I don't believe anyone is that short-sighted.

Comprehensive support for new parents is truly needed and the example of the Michigan County program that was offered by Jillian reflects what would be beneficial in this regard.

What about "just in case"? Although I understand and appreciate the "emergency formula can in the cupboard" argument, it doesn't sway me from my conclusion. In my opinion, anyone who needs the security of formula in the cupboard, can get it at almost any store or they can request a sample from the hospital at discharge for just this purpose.

Simply put, I believe that hospitals should only provide formula to parents who need it or explicitly request it. I do not support having hospitals play the role of marketer for any company.

On a final note, I think it is very sad that parents are judged or feel judged for their choices, parenting it hard enough without that kind of baggage. So let me be clear, my opinion is about what I think is and is not an appropriate role for hospitals. It is not a judgment against people who need to use or choose to use formula.

[Amber]

I'm torn on this one. Really does a hospital need to be giving free advertising???
I nursed my son till 27 months, but had preemie twins born at 2.9lbs & 2.15lbs 2 months early. Without formula my babies wouldn't have made it.
I HATE the stigma of having to formula feed, I have almost left public areas in tears due to the nasty looks I was given. You don't know me, you don't know why I'm giving my babies bottles.
I agree give us the choice in how to feed our babies. Breast is best.... but sometimes there are other reasons for formula that many not appear obvious at first glance.

[Tracy]

A seperate but related issue is...why are moms bring home baby from the hospital the only ones who get the free products? As a mom of a beautiful little Russian girl, whom I brought home at the age of 7 months, I could have used some free formula. Is it impossible for the formula companies to learn about these children? Not at all. Do the US agencies know about these adoptions? Most certianly, I filed paperwork with every major agency from Portland to Washington DC before they let me bring her in the country...but then adoptive mothers have always had a kind of second class seat to biological moms. After all, is a women who (gasp) didn't give birth still a women and more importantly....a mom? Is a baby who came not from a delivery room, but from an orphanage still a baby?

[LTF]

One idea is to write to the formula makers and adoption agencies/states and suggest that they make available free samples/formula to adoptive families. I am curious if they would, since that is a guaranteed market whereas birth mothers may/may not be a market. But, of course, all families must choose a brand of formula, so there is that oppoportuntiy for the manufacturers. Does that sound do-able? potentially successful?

Also, re advocacy around formula, addressing the potential of bisphenol A in formula can liners seems a relevant issue: http://www.ewg.org/reports/infantformula

[Makeshift Mama]

Having formula on-hand feels like a safety net as a new parent. Especially if you can't afford a pump (or can't get yourself to let down for one), it's nice to know that you can run to Starbucks for a break (imagine - a break!) and know that if the baby wakes up, Daddy has something to offer her. I think that formula in a hospital gift bag is a nice thing to be able to stash in the cupboard.

A much bigger deal is nurses pushing formula on your newborn in the hospital. I was told that we had to give my firstborn formula because her blood sugar levels weren't quite as high as they'd like or something like that. She received formula when she was like an hour old. I wish I could go back and tell the nurse to bug off, because I really think that was unnecessary.

[LTF]

Tracy: In thinking about your post on adopting, I am reminded of my life-long assumption that I woudl adopt because it seemed the right thing to do. Instead I had two of my own, whom I love dearly, but at some level feel I failed to do what I thought was somehow more right by the world. while it is clearly complicated and everyone's situation so unique, I admire adoptive families and can't imagine that there are people out there (though I am always amazed by what is actually out there!) who don't see all babies as babies, all parents as parents. sure something to strive for if people can't even get to that point. my intent here was to cheer you on, or at the very least convey that there is one mama out here who sees no difference between me and you, my kids and yours. I hope that is how it came out!

[LTF]

Mothering mag has an article on the effort to "ban the bags" in MA that is worth a look. Two points I thought relevant: 1) when patients receive things from hospitals/care providers they tend to trust them so it is an incredibly brand/product opportunity for forumla makers, and 2) according to this article, hospitals are paid to distribute the samples' that is a relationship that, IMHO, has an inherent conflict of interest. I'd link to the article but Mothering doesn't work that way. it's the current issue.

[catmom]

If you can get past the headline, and read to the end of this article, this English breastfeeding advocate has some advice that goes against the grain:

http://www.dailymail.co.uk/health/article-1022083/No-breast-ISNT-best-baby--extremists-tell-you.html