Just One Bottle?

The latest hullabaloo in breastfeeding blog-land is the controversy over hospitals' supplying formula freebies to new moms, specifically in the context of the take-home bags. There are two issues under discussion here.

The first is that by handing out free formula, hospitals (and doctors) are advertising a product, which many feel they should not be doing. The reason hospitals give out free formula is that they have agreements with the formula companies that if they give (read: endorse) free formula to outgoing new moms, then the formula company will in turn provide free formula to the hospital to use in the nursery. The idea is that once a family starts using a particular brand of formula, they'll stick with that brand for fear of adverse reactions from switching (despite all formulas being essentially the same, and generics costing approximately half of what the identical brand-name product goes for). So, by giving a mom $30 worth of formula as she walks out the door, Enfamil or Similac or Nestle has just gained a new customer for at least the next 12 months, or so the formula companies' thinking goes.

The second issue is that studies show that mothers who have formula readily available at home are more likely to stop breastfeeding sooner or to supplement when it isn't necessary. Thus, mothers who are sent home with formula samples endorsed by the hospital are less likely to breastfeed exclusively for six months and are less likely to continue to breastfeed to a year and beyond, just because the hospital or pediatrician gave them a can of formula.

The first point is more of an ethical argument: Should hospitals be endorsing or advertising one brand over another (essentially identical) one? The second is a health issue: If the goal is for women to breastfeed their babies, then hospitals are undermining their own efforts at promoting breastfeeding by handing out formula as patients walk out the door. An associated problem is that if the hospital gives you formula, then the hospital is tacitly stating that you "can" or "should" use it, even if said hospital is otherwise trying to promote exclusive breastfeeding. It sends mixed signals.

There is one more, less controversial, issue as well. If you go home intending to breastfeed but decide to use formula for whatever reason, simply being handed a can of powdered formula with the hospital's blessing isn't enough. You need to know how to properly prepare and use formula, and if you don't do it correctly, it can be unsafe for a young baby. So if a hospital or doctor is going to give formula freebies, they should also give instructions on formula's proper use.

Okay, leaving that third bit aside, I want to talk about the other two problems from my own experience.

I've mentioned a few times now, if you're a long-time reader, that I had gone into the birth of my first son with the intention to exclusively breastfeed him. However, a difficult birth and lack of preparation on my part led to his being formula-fed. They asked us which kind of formula they should give the baby, and we, not having looked into formula at all, shrugged and asked what they suggested. They told us many moms liked the Enfamil Lipil, so we said sure, why not. When we left the hospital, they were "kind" enough to give us as much free formula as they could (a case of ready-to-feed bottles). When we ran out of those, we hesitantly bought a can of powdered stuff from the store and read the instructions carefully on how to prepare it. Naturally, we bought the Enfamil Lipil, because that's what they gave us in the hospital. He wasn't super-happy on it, so we eventually tried Enfamil Gentlease, which he did very well on. It wasn't until the baby was about 4 months old and I saw that Walmart carried a generic version of the Gentlease for about half the price that we got savvy and started using the generic, especially when we saw that the baby didn't care what brand was in his bottle! It didn't ever occur to me to buy Similac or Nestle, because, by golly, they'd given us Enfamil in the hospital, and that's what we were using! In fact, we were even convinced by Enfamil's excellent marketing that our son needed the additional nutrients found in their toddler formula, and continued using formula until our son started refusing it at about 16 months, at which point he was weaned to exclusively solid foods and cow's milk.

My second son was born at a hospital that gave out custom bags with no formula branding or free formula. I did get some free samples in the mail from Similac, and Enfamil and Gerber generously sent coupons regularly. I kept the Similac samples around but never touched them and eventually gave them to a friend who was formula-feeding. I was so gung-ho and had so few problems with my second son's breastfeeding that, even when I was frustrated, the thought of using formula never even crossed my mind. So having it in the house was not a temptation for me, but only because I was so committed (and obsessed? Maybe). If I had been slightly less so, the difficult times might have been just difficult enough to make "just one bottle" seem very attractive.

My third son was born at the same hospital as my second, and, as mentioned in his birth story last month, the breastfeeding support there was stellar. I again received a very nice, custom bag with no formula branding or freebies. I had intentionally signed up with some baby products mailing lists so I'd get free stuff, but the only free stuff I've gotten is formula. (I was hoping for a diaper bag or something!) There was a can of Similac sitting on top of my fridge for a while, until I moved it to the garage. I have to figure out who to give it to. So far, I don't have any formula-feeding friends this time around! (Not that I'm complaining.)

We brought our third son home on a Tuesday afternoon in September, on the first day of an awful, four-day heat wave. It was 92 degrees and humid. (This is quite unusual here in southern California, especially in September!) We don't have A/C, and the house was sweltering. The baby wouldn't stop nursing, probably because he was uncomfortably hot. His latch was not very good, and my nipples hurt so badly every time he latched on. (If that hadn't improved promptly, I would have gone to a lactation consultant for help!) And he latched on a lot! If I put him down, he'd scream. This went on into Wednesday, also 92 degrees and humid. I asked a friend to come over to meet the baby and keep me company, because I was all alone. She was a Godsend. She played with my other two boys, got us lunch - in the midst of my postpartum hormone surges, figuring out how to handle lunch actually had me in tears - held the baby, and was generally awesome. (You know who you are. THANK YOU for saving my sanity that day!) And the baby just kept on screaming whenever he wasn't nursing. We decided he was just so thirsty because it was so hot, and I had nothing but colostrum.

It was in that moment, the 674th time he latched on that day (okay, I may be exaggerating), that I understood the temptation of "just one bottle." I hadn't understood it with my second son, probably because it was December, I had fewer problems with his latch, and I was so worried that something would go wrong that I was afraid even to think about formula. This time, though I knew I wouldn't actually give him a bottle of formula, I understood why someone might. I needed relief. The poor baby wanted something to drink. If he had something other than my colostrum, maybe he would be happier, and my nipples could recover for an hour or two. Just one bottle... just one bottle...

Another friend of mine, who has a four-month-old, came over briefly to drop off some food for me and held the baby for a minute. He started rooting and screaming (of course). She jokingly said that she did have what he was looking for, but she wasn't sure how his mommy would feel about that. Truth be told, I actually almost asked her to nurse him for me!

Thank G-d, my milk came in Wednesday afternoon, and the baby got a good, long, satisfying feed, and he was suddenly the most content and happy baby you could ask for. It was a miracle. I had started to think that he would be a screamy, hungry monster for six months, and there was no way I could handle that, not with two other kids. I was in tears just thinking about it.

But once he had something to drink, he was fine, and he's actually been incredibly easy-going as a newborn nursling, giving me as much as two to three hours between feedings sometimes, which feels like a great luxury. My second son nursed, almost literally, every hour, so two hours feels like an eternity sometimes! It's nice.

But those first two days, with that can of Similac sitting up there on top of the fridge... Yes. I understand. Just one bottle. Just one. Just two hours of relief. Give me time to shower, apply some Lansinoh, close my eyes. Just one bottle. Just one. You know what the problem would have been if I had decided to give him that one bottle? I didn't have any bottles! (Ironic, eh? I had the formula but not the bottles.)

So, about those free formula samples interfering with breastfeeding in the early days? Yes. They can. Because another mom who had two days like I did, whose baby wouldn't stop screaming when he wasn't nursing, whose nipples were on fire, who had two other boys at home, who was all by herself on her newborn's third day of life, another mom who wanted to breastfeed but maybe didn't know quite as much as I do about how bottles can be a problem early in the breastfeeding relationship, that mom might give in and use "just one bottle."

Now, obviously, anyone can run to the store and buy some formula in such a situation, but it's less convenient, and she might be scared off by the price of a can. Or, in my case, she actually might not be able to run to the store, because she's all alone! But a free sample already in the house, given with the implied endorsement of the hospital, is very easy to tear open and use.

I'm not trying to paint formula or formula companies as evil. It's just business. And if a mom decides she does want to use formula, or wants to try to combination feed, or must supplement because of supply problems or weight-gain issues, then those free samples can be really helpful to have around! But if we're talking about supporting exclusive breastfeeding, which I am, then free formula samples really do get in the way.