Breastfeeding Truths Come Under Attack--IBCLC Fights Back

I have comfortably watched from the sidelines as an ER doctor in Arkansas and one of her cohorts have taken a strange position in regards to breastfeeding. As far as I could tell from her blogs and postings, the doctor and her son suffered an unnecessary tragedy related to insufficient milk transfer right after delivery. No one accurately diagnosed her condition of retained placenta or evaluated the infant for milk transfer and growth. The consequences were dire. The infant did not thrive and the mother may have felt helpless and frightened. I have empathy for her. I share in her frustration. I am angered that the medical professionals and system let her down. What I do not understand is why she isn't lashing out at them. Why doesn't she insist on more observation, better care of moms in the postpartum period, regular assessments of the dyad. She stresses that she wanted to breastfeed, so it seems that it would be logical to take a pro-breastfeeding stand and help others that come after her avoid the same fate. Instead, she is working tirelessly to destroy the Baby Friendly Hospital Initiative, discredit the American Academy of Pediatricians, slander La Leche League International, and question the advice of Academy of Breastfeeding Medicine. The list of her antagonists goes on and on. Her message is destructive. Not only is she pedaling false information, she is also seeking ways to gain notoriety and attention by attacking pillars in the lactation community as well as stellar programs that exist to support and educate families.

Well, I have finally come in her cross-hairs and can no longer sit idly by.  Perhaps I should have spoken up sooner, but I truly felt the anger and accusations she was spewing would be her own downfall. I am responding now because I need to share truth and light in order to dispel shadows and doubt, besides, It is time for me to continue my campaign of evidence-based education backed by references and research.

When my product was recently mentioned in her blog, my first instinct was to ignore the post and focus on helping families. In fact, I would not have conceived this post if the complaints had just been aired on her editorial page. I know my product is well-respected by professionals and health organizations. I know it contains sound advice, backed by science. Unfortunately, I fell compelled to to respond now because a misled individual has gone to great lengths to discredit my work and the evidence behind it. She submitted a claim to the US Consumer Product Safety Commission accusing my product of leading to her son's starvation. Her reasoning is faulty to say the least. I am sharing the Open Letter I sent in response to the ridiculous and almost scandalous complaint she submitted. Let's end her tirade once and for all. Let's call out those who pretend to support breastfeeding but try to sabotage its success. Let's expose lies and half-truth.We cannot embrace "alternative truths" when it comes to infant feeding and public health. There is so much more I could say, but for now I will share my response to an invalid complaint about a powerful visual and important teaching tool that is empowering moms around the world.

For those who desire to see the "complaint" so you can understand my thorough frustration and confusion of why she projects blame on a teaching tool (that was not even widely marketed during the time she experienced) her for her child's condition, well, please refer to the claim she submitted here:

https://www.saferproducts.gov/ViewIncident/1600450

Now for my complete response:

US Consumer Product Safety Commission

Attn: Clearinghouse

4330 East West Highway

Bethesda, MD 20814-4408

January 29, 2017

Dear US Consumer Product Safety Commission and Reviewers:

I appreciate and respect the authority of your office and understand the gravity used in evaluating the safety of products. I recently received a notification that an invention I manufacture and market, the Lactation Lanyard, has been mentioned in a complaint. I am writing to clarify the utility of the product, the evidence that supports its use, and the fallacious nature of the accusations launched against this important teaching tool.

I understand that the complaint has been published and a response from myself or my company is not required, but I would be remiss if I did not respond to the false accusations directed at my product. I assure you that this is not an anonymous complaint by a “concerned citizen” but rather a spiteful person searching for an outlet for her anger and frustration.  I feel compelled to address the complaint and expose the misleading (and selective) information that the author of the submission provided on your form.

The individual who submitted the claim against my product has suffered a personal tragedy (as documented in her submission and on social media) and is trying desperately to find someone or something to blame for her circumstances.

She has gone to great lengths to skew information, and now I fear she has stooped to using your office to submit a frivolous complaint in an effort to execute a personal vendetta against lactation professionals. She has been making these claims on social media and appears frustrated that they have not been taken seriously by a wide audience.

Allow me to share some background information. The person who submitted the claim is part of an organization called “Fed is Best.” Her counterpart wrote a blog post attempting to discredit my lanyards and the established research that validates their utility. This new complaint issued to the Safety Commission appears to be yet another effort to grow an audience for their blog which recently featured complaints about the Lactation Lanyard. The picture of the Lactation Lanyard was removed from the editorial when I threatened a cease and desist letter. Even in the poorly written narrative, the author admits that the stomach capacity of a newborn is unknown, which is not entirely accurate. I am frustrated that this individual continues to spout misleading information in hopes of winning people over to her cause. In this case, the means definitely do not justify the ends. 

Blog by Jody Segrave-Daly, RN, IBCLC

Allow me to address each aspect of her accusations systematically. I believe once the scientific evidence is reviewed, it will be clear that there is absolutely no basis for her claims, and her complaint to the Commission will be disregarded.

First, the Product Detail section on the US Consumer Product Safety Commission report contains false information. The submitter states,

“The lactation lanyard and keychain are visual tools used to convince mothers that their newborns are not in need of supplemental feeding. It claims a newborn stomach size of 5-7 mL when in fact the scientific data has shown it is 20 mL. This is leading to dangerous newborn starvation and brain injury…”

My product is indeed a visual tool that shows the approximate intake of a newborn at day one and at day three, based on the anatomy and physiology of human newborns. The card attached to the lanyard also states that a newborn should be fed frequently and that the stomach grows as milk supply increases. The product comes with an instruction card and website address where we offer additional resources.  The lanyard in no way communicates that a mother should never supplement; that is a medical decision to be undertaken by the patient and her medical, nursing and lactation team. In reference to the last statement in the Product Detail, a visual aid cannot lead to starvation or brain injury; neglect and withholding nourishment can, and we would never condone anything remotely associated with that advice.

The complaint stresses the stomach size on day one. Immediately following birth, families are usually followed by a health professional whether a physician or medical staff in a hospital, or a midwife at a home birth or birth center. Families are cared for and educated by qualified staff who assess a baby for anything out of the ordinary. Knowing many hospitals and birth centers utilize the lanyards encourages me that these professionals share in the belief that breastmilk is the appropriate and sufficient nutrition for newborns, and will advise a family if supplementation becomes necessary. Dyads are closely monitored by health professionals during the postpartum stay, and surveys include tracking weight and output regularly.

The first 24 hours postpartum is mostly about rest and recovery. Newborns take in small quantities of milk during each feed. The exact amount measurable in milliliters is a moot point. When a mother is feeding from her breast, there is no need to use a feeding device and measure intake. Health care professionals have many ways to assess milk transfer, including documenting diaper count. Even though I will share references for the approximate capacity of a newborn on day one, the reality is we are not actually measuring 5-7 mL and feeding with a syringe, but rather feeding at the breast and ensuring milk transfer is occurring. The measurement of 5-7 mL thus reflects the stomach size and not the exact amount of milk transferred.

I am completely bewildered by the author’s paragraph on the Incident Details of the report. It is highly concerning that a Health Care Professional (stated in the submitters report and on her bio), would draw such utterly unscientific conclusions regarding a simple product. The author states:

Lanyards “…prevent them from supplementing newborns who are crying inconsolably for milk when there is not enough. The most recent scientific data shows that in fact, the newborn stomach size is 20 mL using ultrasound and autopsy…these…are leading to accidental newborn starvation and its complications, namely severe dehydration, hypernatremia, hypoglycemia and excessive jaundice which are all know causes of brain injury and permanent disability”

Again, there is not now, nor would there ever be a recommendation to “prevent them from supplementing newborns who are crying inconsolably for milk when there is not enough.” That would not only be barbaric, but unprofessional and dangerous. I will not justify the author’s accusation with further answers.

To address the author’s assertion about the newborn’s stomach capacity, there have been numerous studies performed a variety of ways that give approximations of a newborn’s stomach capacity, but all offer margins of error. There are no perfect studies, and each resource reiterates that the capacity is an estimate.

I will address the three resources the author cited as her evidence of the dangers of the Lactation Lanyard. I believe it will shed light on the situation and reveal the nature of her complaint.

The author confidently states that the “most recent scientific data shows that in fact…” But she neglects to mention that the “new” scientific data is a review of six previous studies. The studies cited were from 1920, 1987, 1988, 1992, 1997, 2000, 2001. Thus, even though the article was written in 2013, it was based on research from as early as 1920. Dr. Nils Bergman, the author of the article cited as documentation for the 20 mL stomach capacity, arrived at that volume based on an average. It is also important to mention that not all stomachs were measured right at birth. The author’s conclusion stated the need for shorter intervals in feeding since a newborn has a small stomach capacity.  I do not believe Dr. Bergman would approve of his research being used to justify a greater volume of feeds since his research centers on promoting frequent feeding, skin-to-skin and Kangaroo Mother Care. The point made in the article is regarding feeding intervals, it is not focusing on stomach capacity.

The abstract clearly proclaims, “There is insufficient evidence on optimal neonatal feeding intervals, with a wide range of practices. The stomach capacity could determine feeding frequency. A literature search was conducted for studies reporting volumes or dimensions of stomach capacity before or after birth. Six articles were found, suggesting a stomach capacity of 20 mL at birth.”

Dr. Nils Bergman’s brilliant work is worth reviewing Bergman, Nils J. "Neonatal Stomach Volume and Physiology Suggest Feeding at 1-h Intervals." Acta Paediatrica 102.8 (2013): 773-77. Web.

The following studies suggest a stomach capacity of approximately 5-7 mL.

Hanson, L., Korotkonva, M., The Importance of Colostrum, Breastfeeding May Boost baby’s Own Immune System. (2002). Pediatric Infectious Disease Jour; 21:816-821

Silverman, W.A.: Dunham’s Premature infants 3rd Edition. Paul B. Hoeber, Inc., Medical Division of Harper and Brothers. New York. 1961. Pp. 143-144

Scammon, R.E. and Doyle, L.O.: Observations on the capacity of the stomach in the first ten days of postnatal life. Am. J. Dis. Child. 20:516-538, 1920

Spangler, A., Randenberg, A., Brenner, M., Howette, M., (2008). Belly Models as Teaching Tools: What is Their Utility? Journal of Human Lactation. May 2008, vol 24; no 2

These studies demonstrate that there is plenty of scientific research that can be found supporting the 5-7 mL stomach capacity reference. There are also many studies that suggest that a newborn can hold a larger volume of fluid. I concur that this is certainly a possibility. What a newborn can consume and what a newborn should consume is also worth mentioning. Newborns, along with the general population, have physiological capacity and an anatomical capacity.

Even if a newborn’s stomach can hold more (as in the case of the autopsied newborns where the procedure to measure stomach capacity took a measurement when the stomachs began to bulge), it does not necessarily mean it SHOULD hold more. Nutritionists promote small, frequent meals as the ideal eating pattern for humans, a practice that seems to naturally begin at birth.

It also stands to reason that if women have small amounts of colostrum on day one, the baby must need small amounts of colostrum on day one. All of the emphasis on research and science laboratory studies is important, but it is equally important to consider the anthropology and biological norm of infant feeding.

The Lactation Lanyards have many uses, including supporting the evidence that newborns consume small amounts of colostrum. This information empowers mothers and gives them a more accurate consumption goal than the 2 oz. formula bottles distributed in many hospitals. If families are not shown the volume for an average feed on day one, they are apt to consider the formula bottle as the standard of feeding rather than the anatomy of the infant.

Even though research has validated the small stomach capacity of a newborn, perhaps the most compelling argument for educating families on the infant’s stomach capacity is corroboration by the most trusted health care agencies and organizations in the United States.  The following agencies accept the information shared on the Lactation Lanyards.

The Academy of Breastfeeding Medicine documents infant’s intake in the first 24 hours to be between 2-10 mL per feed.  BREASTFEEDING MEDICINE Volume 4, Number 3, 2009 © Mary Ann Liebert, Inc. DOI: 10.1089/bfm.2009.9991

American Academy of Pediatrics Section on Breastfeeding documents a newborns intake on days 1-2 will be between 5-10 mL

American Nurses Association http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Breastfeeding.pdf

American Pregnancy Association: “It is normal to make only 1-4 teaspoons of colostrum per day.” http://americanpregnancy.org/breastfeeding/colostrum-the-superfood-for-your-newborn/

The Office of Women’s Health https://www.womenshealth.gov/breastfeeding/learning-to-breastfeed.html

La Leche League http://www.lalecheleague.org/faq/colostrum.html

The support of professional organizations and well-documented research has spawned the development and spread of this valuable teaching tool. Many pharmaceutical companies have similar products to our Lactation Lanyard (see below), yet I did not see any reports on these products.  I am surprised to be personally targeted; it appears that the author’s complaint may be with me personally rather than truly concerned about a product I created. Why have none of these other teaching tools been reported?

The first picture is of the Lactation Lanyard, the following pictures are samples of other very similar items. 

  

The Lactation Lanyard is a portable teaching tool used by health professionals, perinatal professionals, public health educators and breastfeeding advocates. Lactation Lanyards come equipped with double-sided colostrum card and informational card. It also displays the website which provides additional education and resources. www.Birthingandbreastfeeding.com

 Belly Beads http://www.sbbreastfeedingcoalition.org/about-us

Baby Bellies Pocket Keychain

http://www.healthedco.com/53526-Baby-Bellies-Pocket-Model

Many items are also sold internationally

http://www.anatomystuff.co.uk/baby-bellies-pocket-model-pack-of-25.html

Belly Balls http://www.premierhh.co.uk/ardo-belly-balls.html

Baby Bellies Display

Cascade Health Care Products https://www.1cascade.com/baby-bellies-display

Belly Beads Lactation Tool https://snugabell.com/products/belly-beads-lactation-tool/

Stomach Size Badge Attachments http://www.geddesproduction.com/badge-attachments.php

Colostrum the Gold Standard Visual Aid

http://www.childbirthgraphics.com/85156-Colostrum-The-Gold-Standard-Display

Many educational pamphlets and posters are available from companies that support health facilities. A few examples are provided below. 

http://www.childbirthgraphics.com/52069-Baby-Bellies-Tear-Pad-English-Spanish

 http://blog.medelabreastfeedingus.com/2015/04/the-size-of-your-babys-stomach-breastfeeding-in-the-early-days/

https://www.ameda.com/milk-101-article/breastfeeding-guide-for-the-first-12-months/

These complaints seems to stem from the offense the author takes regarding breastfeeding promotion and public health advocacy in regards to breastfeeding supporter. I am assuming that she is unaware that the formula companies also use the same research to educate families about the infant’s small stomach. 

A large formula manufacturer, Gerber, states:

“Your baby’s tummy is tiny at birth—the size of a marble—and grows to the size of an egg around day 10. Many babies eat a lot quickly, so spit-up is common, and often the result of overeating or air entering the stomach during feeding. ‘Happy spitters’ spit up one to two mouthfuls during, or shortly after, each feeding and show no sign of discomfort.
As your baby’s stomach grows and her digestive system matures, the rate and frequency of spit-up will decrease. Your baby will likely outgrow spitting up around the time he can sit up, but it can continue through the first year in some babies.” (www.Gerber.com)

Below are two samples of parent education provided by Similac, one of the top three formula manufacturers in the United States.

 If the author desires to take on the Lactation Lanyards, she must also work to discredit the American Nurses Association, Department of Women’s Health, AAP, ABM, Public Health Agencies, WIC, La Leche League, hospitals, formula companies and many educational institutions. There are a plethora of products and information sheets that she will need to prove provide “unsafe information.” We believe we are in good company and do not feel threatened by the baseless rhetoric being directed at our teaching tool.

In addition to Dr. Nils Bergman’s research, the author of the complaint offered two additional pieces to justify her submission to the Product Safety Commission. One such documentation, I will not address as it is her own blog about her story—hardly evidence-based research. The second is equally subjective, but I will address it as I feel it may be the main reason for her witch hunt.

The submitter shares a story about her son. It appears that she experienced a personal tragedy. The narrative on the report to Commission mirrors the story she shares across social media. Her story clearly states that she was followed by a lactation consultant and a pediatrician following the hospital birth of her son. She explains the feelings she encountered on day four, when she realized she had been starving her baby. There is not one mention of my lanyard in her story. There is not one reference to its use in leading to dehydration. The second part of her story reveals that she was diagnosed with retained placenta, a condition that results in inhibiting milk production (along with other complications). It is pertinent to note that it would not matter if her baby’s stomach capacity was 5 mL or 30 mL, the newborn was experiencing weight loss and dehydration due to little or no milk transfer, not because he had a small stomach. There is absolutely no parallel that can be drawn between our product and her baby’s consequences.  I can only speculate how she must have felt allowing her child to go hungry. She may have been failed by her medical team and may have ignored her own instincts—but whatever led to her withholding food from her newborn is in no way associated with a lanyard. She will have to come to grips with her own feelings and emotions. As a doctor, she is no doubt aware that complications and poor outcomes occur in spite of the best available care. Sometimes, there is not one to blame. https://fedisbest.org/2015/04/letter-to-doctors-and-parents-about-the-dangers-of-insufficient-exclusive-breastfeeding/

I can respect the concerns this individual shares. As a medical doctor working in an emergency room, she undoubtedly faces many difficult situations and hopes to avoid others going through what she experienced. I only hope she channels her energy in a positive, honest way. I question her lack of scientific evidence and knee-jerk reaction to attack those she perceives led to his condition—the science just does not back up her accusations.

According to the About Section on the Fed is Best Foundation’s Facebook page, “Christie del Castillo-Hegyi, M.D investigates the real-life breastfeeding stories of mothers through social media and holds the largest collection of breastfeeding stories in existence on her Facebook page.” I have no idea if her claims are true, but I do know she solicits stories from her followers that include “unacceptable outcomes” from breastfeeding and requests they sign her petition to “Protect Newborns from Brain Injury Caused by Insufficient Breast Milk Intake.”

 Her hobby of collecting stories has apparently caused her to put metaphoric rhetoric above science. She is creating her own truth—a very dangerous practice.

I believe I have done due diligence in refuting the complaint issued against the Lactation Lanyard. Not only did the submitter not prove the lanyards to be a safety concern, she used your organization and submission process to pursue a vendetta as publicly as possible. She has wasted everyone’s time engaging is this dispute.

I personally feel that Dr. Castillo-Hegyi acted irresponsibly in abusing the Public Safety Commission Office by submitting an unfounded, frivolous complaint. She has selfishly added to the demands of your office and consumed a considerable amount of my time in her efforts at self-promotion. I understand from the description on your website that this complaint should have never reached your office.

The U.S. Consumer Product Safety Commission (CPSC) is an independent federal regulatory agency that was created in 1972 by Congress in the Consumer Product Safety Act. In that law, Congress directed the Commission to "protect the public against unreasonable risks of injuries and deaths associated with consumer products."

From the statement on the complaint form, the submission was regarding information and how one individual was able to twist it to her perception. Your office handles complaints about a product. If your office is now in the business of handling complaints about information shared, then perhaps it is time for me to issue a counter-complaint about Dr. Castillo-Hegyi who apparently is offering fear-based education and is negligent in respecting the policy statements of her medical professional associations that recommend exclusive breastfeeding for the first six months as the optimal feeding advice.

In closing, I realize the US Consumer Product Safety Commission receives numerous complaints and must take each one seriously. However, I was disappointed that there does not seem to be an independent investigation prior to publishing complaints. A quick Internet search would have verified our tool has not been responsible for any harm and promotes the same information shared by our US health agencies.

I can sympathize with the doctor’s predicament, and her desire to find a cause for her son’s condition, but I do not respect her accusations against a product that promotes breastfeeding and supports every major health organization’s recommendations (WHO, CDC, AAP, ACOG and many more).

While the physician submitting a complaint was undoubtedly beside herself when her child became ill, my Lanyards cannot be faulted.

The author of the complaint shares her personal story as validation that the Lactation Lanyards caused dehydration in her infant. Let me reiterate: the Lanyards come equipped with a double-sided instruction card that explains that an infant’s stomach grows rapidly and babies must be fed frequently.

The size of the infant’s stomach is a moot point. No matter how small a newborn’s stomach size is, if a mother is not producing any milk due to retained placenta, the baby will become dehydrated. It is my professional opinion as an International Board Certified Lactation Consultant (IBCLC), that this scenario occurred due to insufficient milk transfer due to low milk supply. The diagnosis of retained placenta is of utmost concern. I am perplexed that a family doctor would try to blame a three dimensional teaching tool on her child’s condition. She shares the rest of her story (most likely what lead to low milk supply) here: https://fedisbest.org/2016/10/the-rest-of-my-breastfeeding-story/

This complaint appears to be an attempt to promote her blog and discredit science for personal gain and notoriety using the US Consumer Product Safety Commission platform. I am sorry your office was summoned for this purpose.

Thank you for your diligence in accepting complaints and rebuttals in an effort to improve safety for everyone.

Normalizing Breastfeeding through Education and Support,

Christy Jo Hendricks, IBCLC, RLC, CLE, CCCE, CD(DONA)

https://www.ncbi.nlm.nih.gov/pubmed/19783000

http://californiabreastfeeding.org/wp-content/uploads/2015/02/CBC-Hypoglycemia-2015.pdf

http://www.thevisualmd.com/visualizations/result/infant_stomach_capacity_as_compared_to_various_foods

http://online.liebertpub.com/doi/abs/10.1089/bfm.2010.9986

https://www.aap.org/en-us/about-the-aap/aap-press-room/pages/AAP-Reaffirms-Breastfeeding-Guidelines.aspx

http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/Issue-Briefs/Breastfeeding.pdf

http://hosppeds.aappublications.org/content/5/9

http://www.lalecheleague.org/faq/colostrum.html

Medical professionals, health agencies, lactation consultants--should always assess the needs of the dyad. When supplementation is necessary or desired, a medical team should provide evidence-based, scientific information. We cannot neglect families by pretending to know what is best for their situation, nor should we use fear to force persuade them to breastfeed or formula feed. Human milk will always have benefits for humans--it was designed that way. Each mammal produces species-specific milk for their offspring. We must empower women who desire to breastfeed and support them to the full extent. 

Breasts Plan to Breastfeed--Don't Let Them Down

I think advocates have exhausted the mantra that human milk is best for human babies, but breastfeeding does not exclusively benefit baby. I believe Mom is often left out of the equation. In fact, if breastfeeding were only about the baby's nutritional needs, than perhaps someday there could be an adequate substitute--but it isn't.

Approximately sixteen weeks into pregnancy, a mom is notified via tender mammary glands, that she is, indeed, expecting. Her body is starting the preparation for future breastfeeding. An amazing, complex factory has commenced production of cells, aveoli, ductile work and Montgomery glands. There is even an increase in the pigmentation around the areola to create an obvious target for the baby once he arrives--make no mistake, the breasts are planning on breastfeeding.

Milk Synthesis explained 
http://www.thevisualmd.com/videos/result/milk_synthesis_pathway

The attention given to every detail is absolutely mind boggling. The stage is set in precise detail. The breasts have prepared for breastfeeding like an athlete prepares for the Olympics. They are focused on their one job, and poised to perform. Imagine the disappointment when they are "letdown" postpartum. They never get to realize their full potential. Who is speaking up for the rights of the ta-tas? They have painstakingly prepared for this precise moment for nine consecutive months. Not only is is disappointing, it also poses serious health risks. Just like atrophy sets in when muscles cease to do what they were designed for, abandoning breastfeeding creates serious complications as well.

What happens when breasts are told, "You're Fired!" and are not chosen to fill the primary feeding position? Well, it isn't pretty.

Following birth, Mom's uterus is in need of some serious repair. The best way to return this muscle to it's pre-pregnancy shape is to contract the muscle--a phenomenon that is executed through breastfeeding. This is the most effective way to strengthen the muscle and reduce blood loss. Moms should plan on breastfeeding for a thorough workout, after all, they cannot walk into a 24 Hour Fitness and use the "uterus machine" to tone up.

Recovery continues as the baby continues to breastfeed. Mom may experience significant weight-loss as she burns more calories breastfeeding. The benefits do not stop when baby weans, they continue for a lifetime.

It is as though Baby says, "Mom, I need you to be around a very long time. I need your lap to sit on and your hand to hold...I need your advice when I'm a teen and in my adult years...I need your hugs on birthdays and every morning...I need your kisses on my scraped knee and broken heart...I need you at my wedding and at childbirth...I need you to be the grandmother to my children; and here's how I will make that happen--breastfeed me."

If Mom chooses to breastfeed, Baby will protect her from many immediate and future ailments. Breastfeeding moms experience a reduction in breast, uterine and ovarian cancer. Breastfeeding also lowers the risk of postmenopausal osteoporosis. Breastfeeding moms profit from the hormone Oxytocin, which helps to stabilize moods.

I hope we are encouraging women to listen to their bodies and listen to their babies. They should be entitled to receive all the advantages and bonding associated with breastfeeding. I know not everyone has the opportunity or freedom to select breastfeeding and they must rely on milk donations, supplements or a combination of both. I sympathize with them and understand their plight personally, but still want to convey for those who can, that they (not only their offspring) will reap the rewards.

Order your copy of the poster above http://www.birthingandbreastfeeding.com/store.html

Breastfeeding is a relationship. A bond between Mother and Baby. A beautiful contract to support each other in health and well-being. Maybe breastfeeding and mothering isn't a thankless job after-all, maybe we just aren't making moms aware that their baby has a tremendous gift they want to give, but only by breastfeeding can it be received. Let's commit to empower moms and enable them to accept this life-giving gift.

Formula Companies Dare to Compare Imitations to the Real Thing

This post is about advertising, marketing and deception.  We as educators, public health professionals, moms, citizens, consumers, tax payers, etc.  have to demand honesty in advertising--especially from the formula companies.  These companies use inferior ingredients, cut corners in production, and then lie about its value, causing customers to flock to the registers with complete peace of mind.  As consumers, we question the quality of what we purchase and we want what we pay for...then there's formula...


I made some tongue-in-cheek posters last week.  I am a very visual learner, so I created a visual.  I was attempting to show the stark difference between formula and breastmilk in a vivid, humorous way, but the humor was lost on some.


My posters showed the stark contrast between artificial infant milk and breastmilk.  The superiority of breastmilk is not a new concept, but rather a well-documented, well-established, scientific fact. The two are NOT created equal.  In fact, by law, every can of formula must explain that breastmilk is superior to the product contained therein.  One is a man-made, synthetic recipe; the other a natural, organic species-specific food.  Just like vitamin C tablets are not as potent or healthy as natural vitamin C from real fruit consumed; formula (artificial breast milk) is not as healthy as natural, species-specific breastmilk.

Most of the people who viewed the photos I posted gave it a "thumbs up" and some re-posted. Facebook is pretty good at tracking where posts travel via shares and the subsequent comments.  It was the dialogue that surfaced on some of my friends' pages that truly concerned me.  I realized for the first time how successful the formula companies are at not only dominating the infant feeding market, but also controlling the critics that may voice any opposition.  They conjure up feelings of guilt, anger, fear, disappointment and frustration--not for their product or marketers--but at those who may want to point out that their product is inferior...how did they accomplish that?


One irate commentator "shouted" obscenities and cursed the person who made the poster...strong, emotional response--was this response to the false advertising and implied similarities of formula and breastmilk?  No, as far as I could tell, the reader took offense at what she perceived the message insinuated...that she was a "bad" mother. Nothing could be further from the truth.  I even prefaced the ad with the following remarks

"Just a visual reminder that no matter how the formula companies try to package it, formula and breastmilk are NOT created equal...another thought on the deceptive advertising of formula...(not-and never will be-an attack on those who use it...)"

If a mom gives her infant formula to ensure survival she is definitely a good mom!  There are many legitimate reasons to use or supplement with formula (adoptive moms, foster moms, dads with custody, moms on certain medications...all rely on the nutrition adequacy of artificial infant milk), but still the reader saw:  formula=bad mom; breastmilk=good mom; and I was absolutely, positively judging them!  When a company can cause formula-using moms to take things personally they have achieve a great accomplishment. These companies have undoubtedly succeeded in attaching feelings to facts and substitute perception for reality.


Then there was responses from colleagues in the lactation field.  A couple stated that although they know the risks of formula feeding, they anticipated that people might be offended and riddled with guilt if they were to share my photo on their wall.  Now, this is where the formula companies really hit the jackpot.  Not only do they promote their product, but they also have successfully silenced the opposition.  Really?!  Professionals can't share that there are risks to formula-feeding without retaliation?  Are we free to share risks of not using a car seat or feeding infants honey, egg whites and peanut butter?  What if parents want to give these foods to their children?  Does that mean I am prohibited to share the information for fear of causing guilt? Of course not, but these other safety and feeding recommendations do not elicit the same emotional response the formula warnings do.


It appears as though formula companies have even found a way to convince breastfeeding advocates to keep silent about opinions and concerns.  Even as I write this, I have a bit of fear and trepidation about how this blog will be received.  Will people understand that I want to educate, and that my heart is in helping moms regardless of what their feeding choice is?  Will readers understand I am campaigning for honesty in advertising, or will I fall victim to the scandal that all opposition is insensitive and cruel?  I really am at a loss for how to change perception.  I hope others will help me turn the tide of perception by sharing this post.


What other company can get the loyal consumers on board and silent the opposition? Formula is a taboo subject to discuss in any circle. It has a protective barrier around it and is off-limits when it comes to criticism.  How did they ever achieve this marketing phenomenon?


I am also a bit perplexed and maybe even in awe at how the big formula companies have succeeded in promoting their imitations as "close to the real thing." No one believes that artificial infant milk is as good as breastmilk, but the nation accepts that it is "close enough."  I have to congratulate the conglomerates for their marketing genius and their ability to control perception.


I often stand in front of a group I am teaching and take a side step to my left and boldly announce, "I am now one step closer to China." Of course, I am no where near China, but one step closer.  Recently, I created this poster to convey the same message:

Here's another way for me to put this in perspective.  If a young couple walked into a jewelry store, while window shopping for an engagement ring, and a savvy salesman produced the sugar-coated ring pop with the description that it is "closer to a diamond than ever before," the customers would be outraged, insulted and storm out of the shop (of course the guy may still nonchalantly ask, "how much for the beautiful topaz").  The point is, we are wise to manipulation--especially from salespeople. The candy sentiment may be beautiful, shiny, slide nicely onto the ring finger, but it is not the same as a diamond--and how dare a jeweler insinuate that it is!

Would honesty be appreciated?  Absolutely...the same salesman could have said, "I have this replica that could serve the purpose of a symbol during the nuptials.  It isn't a diamond.  It is made of hard sugar, but you can use it as a stand in."  Then the couple could make an informed decision.  Most would prefer the diamond, but no one but they know all the circumstances.  Maybe a diamond is not an option.  Perhaps the bride has adverse reactions to metal and the plastic alternative is perfect!  They can confidently select the confectionery token without any guilt.  Content with their choice, they are still happy for those who can buy diamonds and understand that diamonds are superior, they do not try to argue the incredible investment that ring pops are and become outraged when anyone suggests that diamonds are superior. It would be ludicrous.


Take the next scenario.  A customer steps onto a used car lot.  Just the location puts people on the defensive by anticipating lies or stretching of the truth.  I'm not saying it's right or even warranted, just a matter of  car lot facts. The car salesman approaches the on-looker with a beauty to sale.  It has four wheels, a new paint job, will get you where you need to go and is "just as good as" the Lamborghini parked adjacent.  Really, who are you kidding?!  Consumer Reports are out and the little, plastic toy does not beat the sports car in any category (well, except MPG--which could actually be a good selling point in this gas war).  The real kicker comes with the sticker price...the dwarfed vehicle is actually priced higher.  The salesman blames inflation and the premium parts that have been used in construction.  Once again, no sale.  We are not going to be duped by a smooth talker.  We are going to look under the hood, kick the tires, and we may in all actuality purchase the little car...not because it is better--or even as good as--the hot rod, but because we need transportation and it is a viable option, but not because we "bought the lie."

Now, let me attempt to share the how these same analogies are used in formula promotion. The impracticable, ridiculous sales tactics mentioned above are laughable, but when marketing experts use them to promote formula, they now miraculously work!  The company passes off an inferior product as the real thing.  Customers are promised that it is "closer than ever to breastmilk."


How can they make these unsubstantiated claims?  Professionals working in the advertising world will attest that these phrases can be legally used if even the color is closer to breastmilk than it was previously.  The American Academy of Pediatrics, World Health Organization, UNICEF and the Department of Public Health all try to expose the deceptive marketing to no avail. These companies seem to be untouchable--even with facts.


Not only are established organizations' warnings rejected, friends and family attempt to share the truth about formula and the "Ring Pop crowd" embraces a mob mentality.  All of the sudden well-meaning friends are labeled "Breastfeeding Nazis" or "Lactivists."  Why is the truth so threatening?  Why would sharing the truth be interpreted as "making formula-feeding moms feel guilty"?


Here's a confession, just because I feel like readers may think I cannot relate.  I formula-fed my first child.  Not exclusively, I breastfed when it was convenient. Do I feel guilty when I hear how certain risks are increased with formula-feeding.  No, absolutely not.  I was convinced that formula and breastmilk were equal.  My nurse gave my son formula...she was older, "wiser" and had more children than I, so I deferred feeding to the lady Nightingale.  Now, I am upset that no one shared the truth with me. No one said the manufacturers cut corners, use inferior ingredients and market their product in order to please the share holders because it is a commodity that people heavily invest in...that would have been helpful.  I also put my son on his belly to sleep--another sign of the times.  I would do things differently now.  A lot of us would.

I have friends, family and clients that have had to use formula to feed their infants.  They do not feel guilty either.  It is a matter of fact.  They almost all would have preferred breastmilk, but it wasn't an option.  They knew the facts, were informed and also admit that scientists and other experts are correct in stating that breastmilk is the best choice. They are not part of the crowd that takes remarks personally.


Remember, by law every formula company has to confirm that breastmilk is superior to formula.  They have to print it right on the packaging labels, but do we get angry at the formula companies for this atrocious declaration? No, we direct our anger at a friend, family member or random individual that posts something on Facebook.  Wow, how do they do it?

Why have my ads elicited such emotional responses from some people?  Once again, I think it is part of the marketing.  


Please indulge me as I share another personal analogy of artificial food.  TPN  (Total parenteral nutrition) keeps getting improved upon...it is "closer than ever to nutritious food."  My dad had to be on it to get nutrients that he couldn't get by eating food, we appreciated the medical advance, but wouldn't have chosen it as our first choice, we knew food was preferable...it was just a matter of fact that we would need to use it to replace food to sustain life...we didn't feel guilty for using the TPN, or offended when professionals explained there were risks to using TPN as a food alternative, I understood it was lifesaving, but I was also happy for the rest of my family that could eat whole food...no one ever tried to convince us that TPN was equal to whole food...doctors and nutritionists were very transparent. Why is formula any different?

These are some final remarks and observations that I believe help the formula companies perpetuate a feeling of guilt when someone mentions the formula vs. breastmilk topic.  Moms feel guilty. That is a fact. Formula companies know this and they take advantage of moms during a vulnerable time in their lives...they play on a temporary weakness.  Moms assume the "fight or flight mode" and fight off a perceived attack...guns are cocked and everyone is ready for a fight...we will defend ourselves at all costs...good meaning friends must also be aware of this delicate time in a mother's life and assume a protective role as we educate.  That may seem like an oxymoron, but it is possible and preferred. 

How else can we combat the advertising moguls?  We must figure out a way to remove feelings from formula.  Just like readers had to try to remove feelings from fact as this article was being read.  It's difficult because perception is reality.

So what can we say about formula?  The truth.   formula was created to sustain life by trying to replicate breastmilk, much like TPN is used, but that does not make it the same as breastmilk...education and truth can go along way, and everyone deserves to be informed...

Sometimes there is no choice, but given a choice, it only makes sense...

I hope this doesn't come across as segmented.  I have a lot of thoughts and this blog has taken way too much time to compose, but I have been cautious and rewritten it a few times.  I will just have to submit it to the public after I make a final note to my lactivist friends: we must be extremely cautions to never confirm what the formula companies try to insinuate: that guilt and fear, depression and anger should be directed at lactation consultants.  If we make clients defensive, we are promoting the formula companies agenda.  We must be honest, sincere, gentle, supportive and loving (in fact, maybe even a little more than we naturally are).

Hope this provided some food for thought...
Christy Jo Hendricks, IBCLC, RLC, CD(DONA), CAPPA CLE Faculty


Hope you can join me for a lactation training in the future...together we can make a difference
http://www.birthingandbreastfeeding.com/

Preface to The Truth about Infant Formula

I have been asked to share the information about formula and advertising that I presented at a recent conference concerning infant formula and how it is marketed in our Western Culture. This will undoubtedly have to be a multi-part series, so let me begin with the Preface.

Scientists, doctors, nurses, medical professionals--all agree and validate the fact that breastmilk is not only the ideal food for infants, but also that children can experience sickness and disease if it is withheld from them, yet, mothers still turn to formula as a legitimate alternative to breastmilk.  Families are targeted by an industry that spends millions of dollars annually to advertise.  They invest heavily in misleading unsuspecting audiences and unfortunately, the payoff is great. According to Companiesandmarkets.com, baby foods and infant formula market is projected to reach about US $2.3 billion by the year 2015.

There's an entire history of formula that hopefully I will be able to write about later.  But in a nutshell, formula was just that a "formula" concocted to sustain life in a moment's notice--in emergencies when a mother was unable to provide breastmilk and a wet nurse was unavailable.  It was a scientific breakthrough and an incredible contribution to the medical world.

History does not only repeat itself in regards to formula advertising...it practically mimics the tone and inflection of each word as noted in this 1920s ad.

A good history lesson written can be found at Dispelling Breastfeeding Myths

I like to compare infant formula to Total Parenteral Nutrition (TPN). TPN is nutrition given via a catheter when a person cannot tolerate food.  There are risks of infection, blood clots and other complications.  It is not ideal, but is a legitimate substitute in dire circumstances.  As useful and necessary as TPN is, a medical professional would never say, "TPN is easier than preparing food and it has all the ingredients that food has, so you can just TPN feed."

I hope my point comes across graciously.  I know there is a place for formula (artificial baby milk), but its place is not in the gut of a baby when it is not medically necessary.  There is a hierarchy of infant feeding that begins with mother's own milk, goes through the list of donor milk and finally ends with formula, but make no mistake, formula does do it's job at sustaining life, and the "formula" has improved over the years. I don't think the formula product is the real culprit in our battle to encourage breastfeeding or to educate moms, but the advertising techniques and the misleading information being promoted is what we must expose and combat.

My next posting will undoubtedly contain several photos and formula labels depicting the false advetising, but as a sample, I will demonstrate some "misleading" advertising on the new Enafamil Premium box...the side of the box boasts: "New! Natural Defense Dual Prebiotics for digestive health.  Enfamil Premium provides these three proven* benefits...

The front of the box mirrors these statements:

The discerning individual will trace the asterisk (*) and try to locate the information that expounds on the study, one must look hard to locate the additional information...kind of like "Where's Waldo"...not only is it small print, but it also lays at an unnatural angle.  People read left to right and would naturally turn their head to read the statement, but the clever (well planned) placement of the note forces the reader to turn the box upside-down to solve the puzzle...yes, this is strategic.  Also, the phrase "Natural Defense" is a trademark, it does not mean that this formula has an actual natural defense, the trademark name suggests the like, but once again it is strategic advertising. Even the packaging and labeling attempt to lure consumers.  The new packaging is a gold, metallic box with the name "Premium." posted predominately on the front. Just a glance across the supermarket shelves reveals that a savvy advertiser has this box shouting, "Pick me!"

Another aspect of advertising would be the violation of the WHO Code, once again something that needs mentioning, but would constitute another writing segment.  There is some good information already in print about the Code and how it is being violated on a regular basis by formula companies.  Jump over to the 24 page pdf of the WHO Code of Marketing of Breastmilk Substitutes to read the original Code, then dive into some of the blogs and articles showing how the Code is violated on a regular basis.

• Nestle Violations and Obesity
• The International Baby Food Action Network
• The Spectrum of WHO Code Violations
• http://www.draparrilla.com/pdf/formula_labeling-violations.pdf
• Ontario Public Health Position Paper

My favorite media clip of the Code violation was created by some of my GOO Students as a class project this year.  They used the "CSI" approach and arrested a can of formula for being in violation of the Who Code and announced that the formula was going to be put in the "can."  I had it posted on my site for awhile, but lost it over time...great concept though...someone needs to hold the companies accountable.

This part may get a little off track, but what about Fair Advertising, violations of the WHO Code and class action litigation, and the National Advertising Division's involvement with regulating advertising?  Well, STATE COURT CLASS ACTION SETTLEMENTS:  A PATTERN OF ABUSE AND A 
PROPOSED SOLUTION made the following observations and cited the lawsuit Free v. Abott Laboratories

Every year, thousands of class actions are filed in the United States – the vast majority in our state court system.  The attorneys who file these lawsuits purport to represent thousands or even  millions of allegedly injured individuals.  But too frequently, the interests of the supposedly
injured parties are not really represented at all.  Instead of pursuing the interests of their supposed clients, the attorneys strike a deal under which the money ends up in their own pockets– rather than the hands of the supposedly injured parties they claim to represent.  The result is more and more class action filings, concentrated in certain state courts, and a growing pattern of settlement abuse.

 Free v. Abbott Laboratories

 In this infant formula antitrust action, the district court concluded that the proposed settlement was neither fair, nor adequate, nor reasonable, because members of the class would receive no more than four to six dollars (a tiny fraction of the $4.3 million dollar settlement) each, while their attorneys would receive $1.5 million dollars.  

Even when these companies have to "pay the price" they pay it to the pockets of attorneys and the media rarely considers the rulings newsworthy.  Exposure of lawsuits, recalls, detrimental chemicals found in formula, bug parts discovered in powdered cans--all need exposure and media attention on a regular basis, not just as a means of promoting breastfeeding, but to scrutinize formula for mothers that trust it to nourish their young.  Accountability is always a good thing.