Dear Serena Meyer, RN, IBCLC:

Your post has made unsubstantiated accusations and we would like to respond with the truth. Please start by reading our actual statements and the science we present, which can be found in our FAQs.  [Note: since Ms. Meyers has now edited her original post and deleted over 200 comments, screenshots of the post are included below.]

You (Serena Meyer) wrote:

Have you heard about Fed is Best? It’s an organization that believes that breastfeeding essentially starves babies, there is a lot of vitriol about breastfeeding and brain damage and death. It makes me feel pretty argumentative.

Every statement issued by the Foundation is cited. We rely on scientific evidence, not “belief.” We have never said breastfeeding starves babies; we have provided factual educational information that exclusive breastfeeding with insufficient supply or transfer can lead to acute and/or prolonged starvation. “Starvation” is a medical diagnosis, not “vitriol” or fear-mongering.

The name is a real teeth clencher for me and other International Board Certified Lactation Consultants. “Fed is Best”, is a highly charged three words that no one really wants to disagree with. The rhetoric flows untapped within their organization and it appears that they drop all the hot words on parents; words like “starvation” and “dead” are used a lot in their materials.

Of course, no one wants to disagree with the words “fed is best.” Do you know why? Because it is a law of nature that sufficient calories are best for a growing and thriving baby. Do you deny that insufficient colostrum and breastmilk leads to starvation and eventual death? Do you deny that it has happened even with maximal IBCLC “support”? You don’t speak for all IBCLCs; many are not “clenching their teeth” and have joined our team after encountering cases of infant starvation and maternal devastation.

If you look deeper into the organization it was started by a MD with an agenda that arose from her personal tragedy but quickly became combative (see her trolling the Academy of Breastfeeding Medicine here in the comment section): https://bfmed.wordpress.com/2016/01/31/of-goldilocks-and-neonatal-hypernatremia/ Hopefully it’s still there.

You have carefully chosen pejorative words here to cast aspersions on us: “agenda”; “combative”; “trolling.” Our mission is to protect babies. We are impassioned, not combative. Dr. del Castillo-Hegyi did not “troll” the ABM, she engaged in an intellectual debate with an opposing viewpoint. Furthermore, the ABM’s article was about her own story. Why would you accuse her of trolling for commenting on a story written about her?

There is misinterpretation of data and selective analysis of small studies. They also have some connection to a group called “Things Lactivists Say”, it appears to be a copy-paste of awful things said by LC and judgmental parents.

Both small studies and large meta-analyses are represented, because they count as evidence, as do case reports (our mothers’ stories). What do you think is an appropriate response to awful things said by LCs and infant feeding shaming? Silence? People need a safe place to vent after experiencing such hurtful words. In addition, many IBCLCs comment on that page as well, and not in a professional manner.

I wouldn’t give FIB too much thought except that it does a lot of social media harm to breastfeeding support- in a culture that by far plays into the arms of formula companies already. The main tone is “You are starving out babies everywhere”. If it galvanizes politicians I worry that it will do much more. Fed is Best is working hard at that and has the funding to be heard. I screen capped their messages to politicians on facebook pages a while ago but they have a way of disappearing.

We are funded exclusively by donations from ourselves, HCPs and laypeople who believe in our advocacy, and parents whose infants have been harmed from acute or chronic starvation. Accusations of industry funding are baseless and nothing more than an attempt to discredit us. It is our right as citizens to message our representatives, so it’s strange that you find fault with that. Our parents’ stories are real, and you can’t accept that because it shows the lactation industry is complicit.

A few years ago the mother of an infant named “L” had an article go viral and it said that if she had given just one bottle of formula her baby would be alive. It’s hard to read and has a picture of her baby on the cover. It is also full of despair and sadness. It is a case of horrible medical mismanagement -but it lacks observable evidence that there was a breastfeeding issue. HuffPost recently rehashed the whole thing with a new rewriting of the original event recently, as this week. 

IF I HAD GIVEN HIM JUST ONE BOTTLE, HE WOULD STILL BE ALIVE.

Is there a reason you did not use Landon’s name?  Why did no one—not the breastfeeding class instructor nor the three LCs involved—disclose the fact that Jillian’s PCOS could affect milk production?  What is your explanation for a baby frantically nursing around the clock and subsequently diagnosed with dehydration and hypernatremia on his death certificate? Perhaps you should read the blog to educate yourself about his negligent lactation care. 

We use his name because Landon was a person and deserves recognition, and he will NOT be buried twice by the same people who were responsible for his short life. 

Friends, I have deep concerns. Let me explain why.  In the mother’s original facebook post years ago, there was nothing about breastfeeding noted. I used to have a link to it but the mother removed it.  Indeed it appeared that it wasn’t until she was invited to share medical records with the creator of Fed is Best (FIB) that they came to the decision that it was low milk supply or poor transfer? I am unsure if she was told by FIB that it was breastfeeding at fault, but the original documentation did not say as much. FIB has certainly promoted the post along with their other heart wrenching material. 

Your accusations are again 100% false. You are slandering the reputation of licensed health care professionals and the Fed is Best Foundation. You are manipulating the facts of Landon’s tragedy to avoid professional accountability. Your accusations have now been considered libelous and we have the legal right to defend ourselves.  If this makes you feel attacked, please remember that it was you who verbally assaulted us. 

Here is the article the mother wrote up for FIB: http://fedisbest.org/2017/02/given-just-one-bottle-still-alive/ I do want to note that I have taken steps to protect the baby’s privacy and I haven’t used his name. It reports that her baby fell unresponsive at home and was readmitted only to lose his life. I do again want to note that I have taken steps to keep her infants identity private but the information is public on her page you may have to search the information out for yourself. 

Should we hold Healthcare Providers to high standards? Yes, yes absolutely. Infants are weighed every 24 hours in the hospital. I have asked for them to be weighed sooner on occasion. Weight loss over specific parameters is flagged and lactation Consultants intervene with strong hospital-grade pumps, we feed expressed milk back in with an SNS or finger feeding, sometimes we offer a small amount of formula but only when the situation calls for it. 

Again, we share (not “promote”) Landon’s story because we and his parents Jillian and Jared do not want this to ever happen to any other baby. In fact, since sharing his story we have learned of FIVE deaths just this year alone. How do we know this? Nurses, physicians, and parents have contacted us, and we will tell these stories too after the medical malpractice cases settle. 

As an RN Lactation Consultant I worked in the hospital and private practice. In fact, I worked in two different tertiary centers, where infants that were born into high-acuity situations were taken care of. I have never heard of an infant that was “Dehydrated’, at birth and given an IV if there wasn’t something already wrong and organs were not functioning normally. An IV for stabilization of blood sugars makes morensense  if regular attempts to raise it with expressed milk or formula failed. I would also note that infants needing immediate medical intervention are often stabilized in the NICU after being moved over to the mother-baby unit. I do not see mention of that. So it seems like fact manipulation or misunderstanding.

If you would read Landon’s blog, the medical information is there, and it would clearly answer your accusations and expose your gross knowledge deficit; as an RN, you should know how the neonatal resuscitation algorithm works. Landon was not dehydrated at birth. He had an 8 and 9 APGAR score, and because he experienced a partial cord prolapse, an IV bolus of 34 mL (or 10 mL/kg) was given to help him recover from shock. That’s it. Expert routine care was given to him by the NICU team. Landon was required to have 2 hours of observation in the special care nursery per the hospital’s protocol. He was brought out to the mother-baby unit was cleared to be in my room at all times. He had normal vital signs and exams, at every shift, as documented in his medical chart. But what wasn’t normal was his constant breastfeeding. According to the experts at The Fed is Best Foundation, if he were sick or unstable, it would be impossible to have any energy or stamina to constantly breastfeed. 

Why does any of this really matter?  Because it gives an organization that is already full of dangerous anti-breastfeeding rhetoric, more fuel to scare mothers into perhaps unneeded interventions. 

The small foothold that lactation support has is so easy to destroy. 

“Small foothold”?  Every major medical organization currently recommends exclusive breastfeeding from birth to 6 months, in spite of the fact that they know that about 22% of mothers cannot safely do this. The WHO has said, “it is not a priority” to educate parents about the risk of insufficient milk production. We know that parents do not get the social and political support to either have six months of parental leave or be guaranteed pumping time and space at work. We are not trying to “destroy” lactation support—we are trying to ensure your recommendations are safe, achievable, and respectful of parental choice. 

Also, I worried that this organization will find a way to boost formula companies’ unethical marketing techniques, try this video here: https://youtu.be/ME6U-zIv6SA if you have no idea what I mean. Formula companies would lovvvvvvve to restart formula sample bags; all known to sabotage breastfeeding mothers. 

We support any safe method of supplementation when needed: mothers’ expressed milk, screened banked donor milk, generic, brand name, or hydrolyzed formula. We have trademarked the phrase “Fed is Best” and regularly send cease and desist letters to prevent any company from using our message for financial gain. We share your concern about unethical marketing, but that does not justify hiding information about appropriate food for babies who need more than the amount of breastmilk that is available. 

Should we hold Healthcare Providers to high standards? Yes, yes absolutely. Infants are weighed every 24 hours in the hospital. I have asked for them to be weighed sooner on occasion. Weight loss over specific parameters is flagged and lactation Consultants intervene with strong hospital-grade pumps, we feed expressed milk back in with an SNS or finger feeding, sometimes we offer a small amount of formula but only when the situation calls for it. 

We have never suggested not giving EBM, or giving more formula than a baby needs. We define “need” as whatever amount the baby is telling us he needs, not arbitrary amounts based on outdated information. Babies deserve to feel satisfied after every feeding, just like any human. If exclusive breastfeeding satisfies the baby, great!  If not, temporary supplementation can buy the time needed until EBF can fully meet his needs. 

Do you know why we don’t dump a crap ton of formula into babies? It’s because breast milk production requires work. The infant must actively suck to tell the body to make more milk. With interventions of large amounts of supplement, the baby is sleepy at the breast. If no one tells the mother to pump her breast, her breast thinks there is half of a baby.

“Crap ton of formula”?  Would you ever refer to an abundance of breastmilk as a “crap-ton”?  No, because it’s disrespectful and unprofessional. 

The next feeding rolls around and there is less milk it spirals down and then we are increasing the supplement, the mother doesn’t know why her body is “broken” and she feels horrible. There is also the disturbance of GI Flora colonization… but my main focus here is the establishment of a healthy supply and how to prevent health issues in infants. 

Interesting that you place mother’s supply first, and preventing health issues in infants second. We also help mothers with their supply if desired, but an HCP’s first responsibility is to support robust health for the baby. Your use of the word “broken” is terrible because it implies that the mother’s milk is more important than her loving presence. There is nothing “broken” about a mother with low supply, any more than with a mother who needs a c-section. If a mother uses that word, it’s your responsibility to ensure her that (a) it is not her fault, and (b) it is common and usually treatable with supplementation and milk supply support. In fact, it is the commonly taught idea that low supply is rare that causes her to feel “broken,” not the insufficient milk itself; if you disclosed that it is common and treatable, she would likely not feel this way.

There are other things that can result in a low supply, a preterm or sick infant doesn’t actively pull out enough before they fall into a breast nap. A tongue-tie, a cleft palate, and any other oral anomaly may interfere with overall milk removal. There are also medical reasons for a low supply, breast surgeries, breast radiation, IGT, PCOS, diabetes may delay onset of lactogenesis 2, treatment of preeclampsia with mag can sedate the infant sometimes, abnormal thyroid function, left over sedation from maternal pain medication or anesthesia from a C-section. Sometimes it’s just a first-time parent’s lack of breastfeeding knowledge or them not understanding feeding cues (which is common), that is the problem. There are so many variables in human lactation management. Removing part of that team is not useful.

Do you disclose these risk factors in prenatal breastfeeding classes?  According to our mothers, that never happens. The benefits of breastfeeding are discussed at length, however low supply (if discussed at all) is treated as rare and usually avoided by having an unmedicated birth, nursing in the first hour, and skin to skin contact. As we said above, we are not trying to remove LCs; we are insisting that you be honest and evidence-based. However, if you continue to ignore what we and our supporters are telling you, you will destroy the LC profession without any help from us.  

Appropriate intervention is my responsibility. It is not the mother or parent’s job to be watching for things going wrong. It is my job. Mine. It is also the mother or parent’s job to be watching for things going wrong, but an LC should also be able to identify that.  It’s an important team effort.

Thank you for holding yourself accountable. We have seen many people in the lactation community attempt to shift blame to pediatricians and nurses when there is an infant injury or death. You are correct that it’s the LC’s responsibility (along with the other HCPs on the team) to ensure babies are fully fed. We would encourage you to intervene before things go wrong rather than watching and intervening after the fact. LC education teaches you to intervene if there are signs of dehydration; it is unethical to allow dehydration to happen in the first place. No other area of medicine waits for patients to show signs of dehydration before providing sufficient fluids. 

It is also the mother or parent’s job to be watching for things going wrong, but an LC should also be able to identify that.  It’s an important team effort. This is why an educated and experienced LC is valuable on your hospital floor. We fix issues that are complicated. LC are at the front line arguing with Hospital management about when you get released, when to introduce a supplement, when to use donor milk, what type of feeding plan, ordering you a hospital-grade pump for at home. What happened to this family is terrible. 

Nice use of the passive voice here. It didn’t just “happen”—Landon’s doctors, nurses, and IBCLCs did this to a previously healthy baby. 

If it was breastfeeding management at fault it was likely preventable, but across-the-board supplementation as Fed is Best as [sic] calling for is not the answer.  Throwing out the baby with the bathwater is not a solution. Better medical management and RN Staffing ratios are. 

We have never recommended across-the-board supplementation. Have you even read our feeding plan?  Protecting the baby from risk and stimulating the milk supply is front and center. Our plan encourages patient choice; it does not assume what feeding method is best for all families as is frequently done in breastfeeding education. 

Make sure that an IBCLC is taking care of your baby and family, is the answer. Not sure what we are? Here is more information on how the education varies from an IBCLC to CLE and a CLC: http://nativemothering.com/2013/03/the-alphabet-soup-of-breastfeeding-support/

Most of the thousands of mothers who have written to us and commented on our posts have had IBCLC care. We do not discourage mothers from IBCLC support if you stay within your scope of practice and base your treatment on scientific evidence rather than ideology. 

 #informedisbest #supportisbest

We agree—being FULLY informed and UNCONDITIONALLY supported are best.

Addendum: in the time it took us to write this blog, we received two stories (from IBCLCs) about babies discharged from BFHI hospitals and then rushed back to the hospital for suspected hypoglycemia. Their weight losses were over 13% at <72 hours of life. This is why we will never back down from educating parents, no matter how angry and insulting our critics become. 

Christie del-Castillo-Hegyi, M.D.

Jody Segrave-Daly, MS, RN, IBCLC

https://www.facebook.com/bayareabfingsupport/posts/2812722552086025?__xts__%5B0%5D=68.ARB4te49VIXUoQjMHIeH8AglkR_xg-spdNALB2F19z5xFYUWr3rcpcsXaIdg9EY42W3mm6rwZr7ysYfeeHrWJEjofcKVEmgGAH6PeUQ9IW29wRY1NN4qTQU9WfherwF3_zth06IDQvx497pvyv8DO6KooJ7oVtimWVzsZgqdoXhbo8crXufVBeAqqJAHqwcfT4GGF3HWZSoDUQ9SdYZeszFLZqZzPQqqeFjbUJ86Fpz1wJH1rDVg6KPmqH_fchscr1vYxsLRkyS0bbxgg3Vmzrv-yUBNrF5toy3pyUsa1US8tFRhYxmYoFDlAkqyom2fzBmcp8BKjSaSeHVHQ_bOtsebSg&__tn__=-R

If I Had Given Him Just One Bottle, He Would Still Be Alive.

Jillian Johnson: My Message To Parents During World Breastfeeding Week-Just One Bottle

 

FAQs Part 1: The Most Common Questions Answered At The Fed Is Best Foundation

http://fedisbest.org/2019/10/faqs-does-the-fed-is-best-foundation-believe-all-exclusively-breastfed-babies-need-supplementation/

http://fedisbest.org/2019/10/do-you-believe-exclusive-breastfeeding-is-a-good-goal-to-promote-faqs-part-3/