Formula "Goody" Bags

I've written before about doctors and hospitals giving out bags supplied by formula manufacturers, specifically here and here. It is a common marketing technique for formula companies - especially Enfamil, Similac, and Nestle/Gerber - to provide "gift bags," samples, and coupons to OB offices, pediatricians, and hospitals to be given out to expectant and new parents. In exchange for the doctors' and hospitals' assistance with marketing their formula, the company supplies free formula to these providers. Their idea is that if you send a new mom home with some free formula and some nice "gifts," she will be more likely to choose your brand if she decides to use formula, and she will be more likely to try using formula if she has some on hand already.

Samples may be anything from a small can of powdered formula, to a few ready-to-feed bottles, to coupons for free or discounted formula at the store. Often, the company will take things one step further and give out diaper bags, insulated bags, ice packs, and other useful items, along with booklets of information about infant feeding.

Research has shown that new parents who have formula samples at home, especially those that they received from their doctor or hospital, are more likely to supplement unnecessarily and are less likely to be exclusively breastfeeding at six weeks than those who do not have formula readily available. Formula samples directly sabotage breastfeeding. (See the above-linked posts for why and how this happens.)

In all honesty, in all three of my previous pregnancies, I did not receive formula "freebies" from my OB or pediatrician. Since my first baby was receiving formula from day one anyway, I did receive samples from the hospital and pediatrician, and I don't know what I would have gotten had I been breastfeeding. With my second and third, formula samples were not offered, and I was exclusively breastfeeding. I did receive some samples and coupons in the mail from joining mailing lists, but I did not receive any from any of my medical providers.

Today, though, I had my third visit with my new OB. After the appointment, I spoke with the billing office about what our financial obligations would be, based on my insurance coverage. After signing the payment contract, I was handed two gifts, one with Similac branding and one from Enfamil. I was excited, because never having received formula goody bags before, I didn't really know what they might be like. Also, it was entirely possible some of the stuff might be useful (ice packs are ice packs, after all), and I was curious to see what I was given. The Similac bag was a nice shoulder bag, while the Enfamil packaging was not in and of itself useful.

I know I personally won't be swayed by the formula marketing, since I have successfully exclusively breastfed two kids already and am extremely confident about breastfeeding this next little guy. I'm not worried that having some formula samples in my house will cause me any problems. I have a purely academic interest in what these bags contain and how their contents might be perceived by a mother less gung-ho than I am about breastfeeding.

I was not disappointed.

I'll start with the Enfamil package. It was a small, cloth bag fastened with Velcro. The label said it is a "birthing and beyond kit" and informed me that it contained ready-to-use formula. Inside were four "Nursette" bottles - two Newborn and two Gentlease - and one bottle nipple. Also included were a booklet on caring for my newborn, a book of coupons for various Enfamil products, informational cards about each type of included formula, and a postcard telling me that I could download the American Academy of Pediatrics' New Mother's Breastfeeding Essentials ebook from Enfamil's website.

The booklet, called "Your new baby - a detailed guide to your newborn's nutrition and well-being" contains a selection of generic advice regarding newborn care, milestones, and development, including a section on breastfeeding. This section is brief, not detailed, and is not complete enough to truly be helpful. They also find ways to advertise other Enfamil products such as their Vitamin D supplement, with a page on why supplementing with Vitamin D is important. The breastfeeding section is immediately followed by a section entitled "supplementing & formula-feeding," with the headline on the first page, "Going back to work - or just ready for a change." They then briefly discuss reasons why a mother might choose to supplement with formula, none of which are situations in which supplementation with formula is medically necessary: "milk was delayed coming in," "going back to work," "didn't feel like baby was getting enough," "mom or baby got sick," "baby had trouble latching or sucking," "pumping was too uncomfortable or inconvenient." This is followed by tips for bottle-feeding and preparing formula. The booklet also directs you to an 800 number or the Enfamil website for "live help."

I'll discuss all of this after we look at Similac's bag.

First of all, Similac's gifts were much more impressive. It starts with a quilted, messenger-sized shoulder bag which could be used for just about anything. It is simply black, with no Similac branding except for the large, removable label hanging from the strap. The bag is called a "Breastfeeding Supplementation Kit". In the bag were a sample-sized can of Similac powdered formula, a black cooler bag sized just about right for two bottles, with two Similac-branded ice packs inside, a Similac-branded booklet called "The Art of Feeding", a chart for how long breastmilk can be stored and instructions for use of the cooler bag, and a pile of coupons for everything from diapers to Disney movies. Surprisingly, none of the coupons were for Similac itself.

The "Art of Feeding" booklet starts out by recommending that mothers take Similac's prenatal vitamin during their pregnancy to aid their babies' development. It then discusses the nutrients a baby needs in its first few days and weeks of life and gives a quick overview of a sample diet for a breastfeeding mother. Next is a several-page guide to breastfeeding, including rough descriptions of the four most popular breastfeeding positions, tips for latching, an overview of newborn feeding habits, and what to look for when it comes to baby's diapers and weight gain. There is a brief FAQ, and then they recommend contacting their "feeding experts" at a toll-free number if you have further questions. The rest of the booklet contains advice about how to wean to formula, how to choose which type of formula to use (of course, Similac offers a wide range of options), how to choose a bottle and nipple (Similac has those products, too!), how to prepare, store, and use formula, and an overview of all of Similac's products.

The first thing I want to draw your attention to is the absurdity of a formula company - any formula company - offering advice on breastfeeding. Take any of this advice with a grain of salt. While none of what they say in either booklet is precisely "wrong," it's also not the kind of detailed help a struggling new mother might need, and some of it is misleading or incomplete. By including this information, these companies are trying to look like they're being breastfeeding-friendly, while simultaneously giving new parents the "permission" they need to supplement or switch to formula rather than try to solve any breastfeeding problems they encounter. By "allowing" a mother to use formula in addition to (or instead of) breastmilk, they are presenting her with a guilt-free "get out of breastfeeding" card. And they offer no real advice about how to know when you actually need to supplement, how to avoid the need to supplement, or how to realistically combine formula and breastfeeding in a way that will not further harm your breastmilk supply. They also do a fine job of explaining why their products are "almost as good as," or "the next best thing to" mom's own milk, and they show a range of products to meet any baby's needs.

Why does all this matter?

Well, let's look at where I got these bags. Who gave them to me? My doctor. By giving me these bags, my doctor is implicitly endorsing my use of formula. She has not given me any information on breastfeeding, has not discussed my choice of feeding method, and has not asked if I need any help making such a decision. I'm seven weeks from my due date. Maybe I'm still on the fence about how I want to feed my new baby. Maybe I haven't even really given it much thought. Maybe I'm being bombarded from all sides by the internet, my family, and my friends about how I "should" do this or I "can't" do that. Maybe I don't trust my breasts and my body. Maybe I don't really "get" how breastfeeding works. Maybe I think it's "gross." Or maybe I have body issues due to psychological problems or sexual abuse and the thought of anyone touching my breasts, even a baby, is nauseating or panic-inducing. I now have a ready-made solution: my doctor gave me formula samples. If I have any doubts about breastfeeding, I now know that my doctor thinks giving me some formula "in advance," "just in case," is a good idea. And if my doctor thinks it's a good idea, who am I to question?

Now, granted, this is my fourth baby, and I've made it pretty darn clear with my doctor, in the short time we've known each other, that I know exactly what I'm talking about and that I have a very clear idea of what I'm going to be doing. So it may be that she sensed I don't need her advice. I don't know how she might be with a first-time mother, or even a second- or third-time mother who is considering breastfeeding for the first time. I may actually ask her at our next appointment if they do provide any prenatal breastfeeding support or advice. One thing I am comforted by is that I got two different brands' bags, so the office is not endorsing one over the other, and they just sort of threw them at me with a, "Oh, yeah, you can have these if you want" attitude. But I wasn't exactly discouraged from taking them, either. And the way it's presented, "Oh, and we have some goody bags for you, too!" makes it sound so exciting and exclusive! Of course I'd want a goody bag!

I'm very interested to see what, if anything, I get from the hospital, if this is what I got from the OB!

Breastfeeding simply can't compete with the formula marketing scheme. Sure, I could get a bag from Medela or Hygeia or Avent or Lansinoh with various breastfeeding accessories such as breast pads, lanolin, and freezer packs. But these companies simply don't have the market share that the formula companies do, and they don't have as vested an interest in gaining you as a customer. You'll never, ever spend as much money on breastfeeding as you would if you buy formula. You just won't. It's not worth it for their bottom line to give out freebies like it is for the formula companies. That leaves doctors and hospitals and midwives and bloggers and lactation consultants to do the leg work of educating the public about breastfeeding.

What it comes down to for me, with this blog and in my life, is this: I don't have any say in what you choose to do, how you choose to give birth, how you choose to feed your baby, or any other of the myriad choices you'll be making as a parent. But, I do care that you make those decisions based on good, solid, evidenced-based information, which is what I try to provide you with here on my blog and if you ask me advice in person or through my social media outlets. There is no disputing the fact that formula is inferior to breastfeeding. There is a time and a place for the use of formula, and I can even give you advice on how and when to use it in a way that won't sabotage your breastfeeding relationship, if you need such help. I hope - I really, really hope - that you won't turn to Similac or Enfamil or Nestle to tell you how to "successfully" supplement your breastfed baby with formula and think that the information they give you is truly accurate.

I know that these formula samples can be genuinely helpful in certain cases when short-term supplementation is necessary. But I also think there are ways to provide such samples to the mothers that need them, without essentially spamming every pregnant mother with something she probably won't need.

As for me, I'm going to keep my bags to use as an educational tool when I finally start teaching my own breastfeeding classes. Raising awareness of exactly what you're getting when your doctor hands you a "goody bag" is a necessary step toward improving breastfeeding rates and successes.

Did you receive formula goody bags from your OB, hospital, or pediatrician? What types of products did you get? How did you feel about receiving these freebies? Did you use any of the products?