I’ve been thinking about something recently. When my daughter Hannah was born at 34 weeks, she was given a bottle of formula in the NICU before I had a chance to try breastfeeding her. When I did try to breastfeed her, she refused to latch. I started pumping, but I was never able to get as much as the doctors and nurses said she needed, so about half of her milk intake was formula. When she left the hospital at one week old she still hadn’t successfully latched, and the nurses tucked a few jars of pre-prepared formula into my diaper bag. That formula only lasted a day or so, so my husband had to go buy a can within 24 hours of Hannah’s arrival home.
Now, I should make something clear: I had really not planned to give my baby formula. I was intent on breastfeeding for at least 12-18 months before my first child was even born. But when you have a premature baby, and many people in white coats are saying that baby needs a certain amount of food, you give that amount. When that baby refuses to latch, and you’re having limited success with pumping, you supplement. Looking back I think that a whole lot of things could have been handled better in general – like, say, not separating me from my perfectly healthy baby within minutes of her birth – but this was one of those times in life when I found myself doing the best I could with the situation I found myself in.
The good news in this story is that the morning after my husband’s trip to buy that big can of formula, Hannah finally latched using a nipple shield. Within 48 hours I had stopped pumping and she wasn’t receiving any more formula supplements. I think we ended up mixing a total of two bottles out of the big can of formula. I kept it for a few weeks just to be sure that everything would go okay, and then I threw it out with glee.
In the years since my first baby was born, I’ve spoken with many other mothers who found themselves giving their babies formula when they hadn’t planned to. Many of these mothers do everything they can to limit the amount of formula their babies receive. I also know moms who go to great lengths to ensure their little ones never receive any formula at all, spending their lives attached to breast pumps and forgoing sleep and showers and regular meals in order to get breastfeeding going.
I think that every mother needs to make her own decisions about just how far she’s willing to go to avoid infant formula. Some moms may not even try to avoid it at all. That’s not really my point here. I’m not writing this to moralize on why breastfeeding is so important. I think we’ve all read the public health messages, and we all know the drill. What’s interesting to me, however, is how different parents will respond to having infant formula available. Will you still avoid it all costs – or will having it in your cupboard lead you to offer that first bottle just that much sooner?
The evidence suggests that mothers who receive formula samples from the hospital are less likely to breastfeed. This is true whether we’re talking about commercial sample packs from a formula company, or nurses tucking a few jars into a diaper bag, which is what I got. To a certain degree, this just makes sense. Regardless of where you stand on formula companies, I think we can all agree that they’re big businesses, and they’re unlikely to engage in a widespread marketing practice if it doesn’t work. Formula marketing – such as handing out samples – is meant to sell formula, and at least some of the time it does that at the expense of breastfeeding.
I understand the evidence, but it doesn’t answer my initial question. Why do some mothers view that formula can on their shelves with extreme suspicion, while others view it as a welcome back-up plan or occasional alternative?
There are a whole lot of factors that influence breastfeeding rates, as it turns out. Here are a few, based on the research:
- Social support
- Knowledgeable and supportive health care providers
- Maternal confidence and intention to breastfeed
- Mother’s age, education level and socieconomic status
- Previous breastfeeding experience
- Whether or not the mother was breastfed herself
- The breastfeeding issues a mother encounters
- Initiation of breastfeeding within 16 hours of birth
Looking at that list I see that there are a whole lot of factors that influence a mother’s breastfeeding experience. There’s no single thing that’s going to determine if a mother breastfeeds, how long she breastfeeds for, or whether she breastfeeds exclusively or supplements with formula. What’s more, any individual mother may have very different experiences from one baby to the next. It’s simply not true that any mom who has a can of formula in her cupboard is going to use it. However, that doesn’t mean we should all buy it, or that formula companies or hospitals should go ahead and hand out free samples “just in case”.
What I think it does mean is that, first and foremost, we need to make sure that mothers have good information and support. When you look at that list, most of the success factors centre around a mother who has access to the resources she needs, when she needs them. Whether it’s health care providers in the hospital, your mother helping you out at home, or a website you search out when you’re looking for information, if you can find the answers you’re looking for, you’re more likely to be successful.
Should we curtail formula marketing? I think we should. But I also think that we need to keep our focus where it belongs, and that’s on parents. The ideal outcome in my book is that parents are satisfied with their own experiences, whether we’re talking about breastfeeding or anything else associated with that transition to early parenthood. Because a can of formula in your pantry isn’t going to really be there for you, whether you ever give it to your baby or not.
What are your experiences with formula samples? Did you receive any? Did you use them? Where do you think we should focus our efforts at helping mothers succeed at breastfeeding? I’d love to hear your thoughts!