July 31, 2012

Latch On, Latch Off: Bloomberg Tells Hospitals To Lock Up That Formula

The Bloomberg administration has persuaded 27 of New York City's 40 hospitals to adopt new, breastfeeding-friendlier procedures for newborns. As part of the new Latch On NYC program, maternity ward nurses are supposed to encourage new moms to breastfeed by default, not hand over a bottle of formula. In fact, the formula's going to be locked up. So if or when they're explicitly asked for it, the nurses will have a bit of a hassle to provide the powder.

It's just like how having to go outside and halfway down the block to stand in a doorway in the rain cuts down on smoking.

The CBS rehash of the NY Post report says the program's voluntary, but the Latch On NYC page refers to the enforcement of "NY State hospital regulations" prohibiting the promotion of formula or any other interference with breastfeeding unless deemed to be medically necessary. And the rest of the program deals with bans on formula giveaways and Big Formula promotional material.

UPDATE: Thanks to Ms. Weinberg, an official from the Latch On program who commented below, to remind us all of the many and varied benefits of breastfeeding to both mother and child.

She also asserts that this post is "inaccurate" to say that the Latch On program will cause hospitals to "lock up" formula, or require a mother to "give a medical reason" to use it. And that the program in no way "restricts access" to those who choose to use formula.

Frankly, I think the best discussion of this is in the comments, where it seems obvious that the objective of Latch On is to alter institutional habits and to counter vast and longstanding corporate marketing by Big Formula. And as such, the city and its program have my full support. Other astute commenters note that encouraging breastfeeding success in the crucial first hour or days requires more than just making formula slightly more inconvenient for nurses. It requires knowledgeable lactation expertise and support for the many women who don't immediately find breastfeeding to be a problem-free, rewarding joy. That proactive support is not included in the Latch On program.

But back to the two major, supposed inaccuracies. The Latch On NYC website states:

Hospitals joining Latch On NYC have agreed to:

  • Enforce the New York State hospital regulation to not supplement breastfeeding infants with formula unless medically indicated and documented on the infant's medical chart

  • Limit access to infant formula by hospital staff

  • Discontinue the distribution of promotional or free infant formula

  • Prohibit the display and distribution of infant formula advertising or promotional materials in any hospital location
So the first and second objectives of the program deal with medical indication and limiting access "by hospital staff." I think Daddy Types' characterization of these objectives is at least as accurate as the NY Post or CBS News's, and in fact is more accurate for including reference to a state regulation on formula use which I have not seen mentioned or discussed anywhere. But now I will search it out.

In any case, if an unwarranted charge of media inaccuracy was the needed impetus for Ms. Weinberg's valuable comments on the benefits of breastfeeding, Daddy Types is glad to take the punch. And then let us all be more aware of breastfeeding by gazing on the invisible nursing-padded bosom of DT's patron saint of lactivism, Uma Thurman, who is probably breastfeeding her new daughter right now. Mazel tov.

Mayor Bloomberg's infant formula plan aimed at promoting breast-feeding in NYC hospitals [cbsnews via dt reader dt]
Latch On NYC [nyc.gov]


It's easier to ban something than to provide enough skilled lactation consultants to actually help new mothers in Hour One with breastfeeding.

My wife, the skilled lactation consultant, approves of the preceding message.

An excellent point. damningly excellent.

I'm sorry, but this makes me really angry. Grown women have the right to choose in this matter without being brow beaten.
I breast fed four of my children but I am not out to force other women to do so.

I definitely see your point. And I'd be interested to see how this really plays out, and what the actual impact is of incentives and processes in what Cynthia called Hour One.

On the one hand, I can see how it could be scolding or condescending. On the other, it could be the slight nudge or alteration that makes the difference.

And if there is a longstanding corporate/industrially driven, formula-centric practice in place that we've become invisible to, that should be called out and dealt with.

Like how when McD never asked if you wanted fries or apples, 90% or whatever of Happy Meals got fries.

As a doula I've seen nurses bring sample bottles of formula to new mothers who explicitly stated they wanted to exclusively breastfeed. "To save me the trouble of walking back down the hall to get it for you later."

Some nurses are great breastfeeding supporters, and some hospitals have great IBCLCs on staff, but formula companies spend a lot of money on freebies in hospitals because it's a tactic that works. Women in the hospital have to ask for lots of things, it doesn't mean they don't get them, it just means they have to ask before they get it. Any woman who needs or wants formula in a NYC hospital will get it.

The outrage over this policy seems way, way overstated. Yes, there are women who have trouble breastfeeding. Yes, there are women who choose not to. And none of them should be shamed or made to feel inadequate as a result.

But there most certainly is "a longstanding corporate/industrially driven, formula-centric practice in place." After each of our kids was born (both in an NYC hospital), they sent us home with a big bag of formula samples and swag. Given my wife's commitment to (and success with) breastfeeding, I was quite surprised at the enthusiasm with which the nurses gave us all the free formula stuff. And these were the Birthing Center nurses, not the "traditional" Labor & Delivery nurses! All that formula swag sent a strong message that we needed or should want it.

In my mind, it's banning the free samples and the swag bags that's the most important part of this policy--more so than the "locking up" of formula that everybody seems so upset about. But even the "locking up" thing makes sense. It's not (or at least shouldn't be) about denying formula as an option or brow-beating mothers into breastfeeding, but about presenting breastfeeding as the default, normal, preferable-if-it-works-for-you way to feed a baby.

If someone knows they want to formula feed, why can't they bring their own to the hospital? You could take it out of your own bag any time you wanted!! Bloomberg wouldn't even have to know!!

We read your blog posting with interest and wanted to respond and address several inaccuracies.

The piece states “In fact, the formula's going to be locked up. So if or when they're explicitly asked for it, the nurses will have a bit of a hassle to provide the powder."

This is actually not the case:

•In fact, the initiative does not require hospitals to “hide” or “lock up” formula, nor does it restrict access to it for those who want it.

•Parents who want formula will not have to convince a nurse to sign it out by giving a medical reason. Parents can and always will be able to simply ask for formula and receive it – no medical necessity required, no written consent.

The piece neglects to mention the positive health impacts of breast feeding for which there is there is overwhelming evidence -- supported by national and international health organizations. For mothers, breastfeeding reduces the risk of breast and ovarian cancers. For babies, breastfeeding reduces the risk of ear, respiratory and gastrointestinal infections, as well as asthma.

The American Academy of Pediatrics has just published new guidance to pediatricians in Feb 2012, reaffirming its support for breastfeeding: http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html

Ultimately, our goal is to support a mother in whatever decision she makes when it comes to nursing her baby and this initiative specifically is designed to support a mother who decides that she wants to breast-feed by asking participating hospital staff to respect her and refrain from automatically supplementing her baby with formula (unless it becomes medically necessary or the mother changes her mind).

Bottom line: It does not restrict the mother’s nursing options in any way – nor does it restrict access to formula for those who want it

thanks for your comment, Ms. Weinberg, and for checking out the discussion here. And please add Daddy Types to the chorus singing the praises of breastfeeding.

And I do hope that the post and the ensuing discussion show that there is little misunderstanding about the Latch On program, or how it is apparently intended to work to encourage breastfeeding: i.e., by changing maternity nurse habits and defaults, and not to "restrict access to formula for those who want it" by "lock[ing] up" formula or requiring "a medical reason" to obtain it.

That said. According to the program's webpage, those are actually the first two things on the list of things that

"Hospitals joining Latch On NYC have agreed to" do. For formatting convenience, I have added that clarification as an update to the post. Thanks again for your comment, and best wishes with the success of the program.

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