Thank you for your long-overdue public acknowledgment endorsing what the Fed Is Best Foundation has been fiercely advocating for over the past 3 years.
1. Delayed onset of copious milk production is common.
BFUSA: “Delayed lactogenesis is actually increasingly common because the risk factors for it are potentially increasing,” Dr. Rosen-Carole says. “When a baby is born into that situation, the goal is to closely monitor what the baby is doing, instead of giving a bottle right away. “If the baby is hungry and they’re not getting enough milk out of the mother’s breast, then they need to be supplemented,” she says.
FIBF: We have been passionately educating parents about safe breastfeeding since the beginning of our advocacy over 3 years ago with the current scientific studies that have confirmed over and over again that delayed onset of milk production and low milk supply are common. We question why it took you so long to acknowledge this deadly and 100% preventable consequence of insufficient breastfeeding? Does this mean you will ban the belly bead stomach models that do not reflect the current science?
Will you please apologize to the thousands of mothers who bravely told their stories of accidental starvation? You have previously tried to discredit their stories, called them “‘anxiety-provoking,” and characterized our foundation as BFHI detractors— simply because we offer a social media platform for mothers to be heard by you. Have you ever heard a mother break down and scream in horror when she learned her baby was starving to death because she followed your breastfeeding education and protocol? We have—over and over again, and it is the most haunting sound. It’s what drives us to fiercely advocate for safe breastfeeding because no other health organization is doing so.
BFUSA: Dr. Bobbi Philipp agrees. “If you see signs that the mother’s milk is insufficient, you need to feed the baby,” she says. “And if the mother is really committed to breastfeeding, you’ve got to bridge the gap in a way that you support her, feed the baby, and don’t undermine the breastfeeding. It’s that simple.”
FIBF: Now that you are acknowledging delayed onset of milk is common, something that we have been passionately writing and speaking about for years, we expect that you will stop calling us “fibbers.” Name-calling is what a child having a temper tantrum does, not what a professional organization should do; the appropriate response to being called out and held accountably, is to take responsibility and revise your guidelines based on current research and patient feedback.
2. Mothers should not be made to feel bad about their feeding choices.
BFUSA: Rosen-Carole says she spends a lot of her time helping patients understand that how much milk they have is not what defines them as a parent. “We need to start divorcing this from the idea that this is what’s going to make you a great mom,” she says. “This is a part of your parenting, but it’s not your whole parenting.
FIBF: We couldn’t agree more!
Does this mean that BFUSA will stop promoting the terrifying and inaccurate risks-of-formula “education” to parents who state they want to formula feed, supplement, or combo-feed?
Mothers tell us repeatedly when they have to sign a formula consent form they experience devastating feelings of failure as if they are harming their babies. No mother wants to harm her baby. Exclusive breastfeeding itself is not the enemy; your protocols that demand exclusive breastfeeding are. Your relentless and baseless demonization of supplemental formula is causing this emotional harm and lingering suffering. Some mothers have tragically taken their own lives because they could not breastfeed.
This mother describes how she felt when her baby required formula…..
Amanda: The first time I fed my son a bottle of formula, I felt like an absolute waste of space as a mother. I genuinely felt like the worst, piece-of-garbage, failure-of-a-parent there was. I felt like I had failed him in every single way. Not only had I starved him and been unaware of it—I felt like I should have just known—but I had to use formula from a can to nourish him because my body stubbornly refused to make enough milk. I felt like anybody could just pick up a bottle and completely replace me in his life. It was a terrible feeling.
3. Individualized care
BFUSA: “It is critical that mothers and infants who are identified prenatally or soon after delivery as being at risk for breastfeeding challenges receive an individualized feeding plan, close observation for adequate hydration and nutrition, assistance to monitor and optimize a milk supply, and close follow-up after discharge,” says Trish MacEnroe, CEO.
FIBF: How can you claim that individualized care is critical when a single milliliter of formula, unless given with a doctor’s order, threatens a hospital’s BFHI accreditation and can have financial consequences to that hospital? Every mother, regardless of whether they are identified as high risk, still deserves individualized care that takes into account her own observations of her baby’s hunger.
4. You “don’t have to convince people to breastfeed anymore.”
BFUSA: With breastfeeding initiation rates now well above 80% in the US, it is clear this public health effort has been successful. Both Dr. Rosen-Carole and Dr. Philipp feel the emphasis shifting to a more collaborative approach.
FIBF: How is it possible to collaborate with the BFUSA protocol unless you change the arbitrary and one-size-fits-all exclusive breastfeeding metric of 80%? Collaboration can only truly happen if your policies become flexible and allow for appropriate supplementation as needed or desired. Your exclusive breastfeeding policies are inherently prescriptive, not collaborative. Will you be changing the 80% exclusive breastfeeding metric now? Will you expand your definition of acceptable reasons for supplementation to include clinical signs of hunger and maternal choice? If not, all you are doing is providing lip service instead of offering real change.
5. Rosen-Carole and Philipp both agree that the most important thing is for the medical professionals in charge to carefully monitor the situation, engage in collaborative conversations with the family, and intervene when necessary to ensure the safety of the infant while also respecting the values and wishes of the family.
BFUSA: Rosen-Carole suspects this is what was lacking in some high profile cases of infant harm reported in the media. “There are many red flags that should have been raised or where the ABM protocol would point toward supplementation,” she says.
FIBF: We believe, and research supports, that supplemental intervention should be the number one priority when there are signs of insufficient feeding; and yes, we agree donor milk should be available for the mothers who choose it. Baby Landon died because your breastfeeding protocol denied him life-saving supplementation while he was in the hospital. The IBCLC wrote on his chart that his mother had IGT and she recommended “herbs” to help increase his mother’s milk supply. Baby Landon needed MILK, NOT HERBS, but instead, he got that nice check-mark to meet the 80% threshold for being an exclusively breastfed baby, despite a nearly 10% weight loss at discharge from his Baby-Friendly hospital.
We are glad you mentioned the 2017 ABM supplementation protocol. It states that crying and fussing for hours are normal signs and do not require supplementation, when those are in fact the signs of insufficient feeding just like Landon exhibited for days. ABM’s 2017 protocol makes reference to cluster feeding only lasting for a few hours but provides no guidance to check for hypoglycemia and hypernatremia as the causes of such crying. However, mothers are being told constant and prolonged feeding around the clock is “cluster feeding,” and this is where confusion that can result in harm begins. There is a point when cluster feeding becomes a clear sign of insufficient breast milk and/or insufficient transfer of milk, and those signs must be taken seriously for the health and safety of the infant. There is no reason to wait until the second or third day of life, as you suggest; a newborn should never experience unrelenting hunger on any day of life. Isn’t the first rule in lactation support “feed the baby”? It’s not “push the baby to the limits of his fasting tolerance to avoid a few milliliters of donor milk or formula.”
It is important to define what cluster feeding really is as health professionals and evaluate and intervene when an infant is in danger of insufficient feeding complications.
5. “Trusting breastfeeding and wanting to support exclusivity doesn’t mean that you ignore the fact that some babies are going to need to be supplemented from time to time. It’s a balance.”
FIBF: Health professionals tell us they have been reprimanded for suggesting formula when infants are showing distress that ultimately leads to serious feeding complications. Now you’re also blaming mothers for “being adamant about not using formula” when your own educational program trains them to view even one bottle of formula as harmful to their child’s future health. BFUSA, you literally tell nurses to discourage mothers from using formula and to “educate them” on the “risks” of formula. We have countless pages of evidence from nurses who provided us with the text scripting they have to follow when a mother was begging to supplement her hungry baby with formula!
BFUSA, In all the infant starvation medical malpractice cases we have been made aware of, the most common cause of infant harm has been lack of parent and health professional awareness of the signs of insufficient feeding and the overwhelming pressure to avoid supplementation. The BFHI policy puts infants, families, health professionals and the entire health care system at risk.
6.“Our main focus now is on helping people reach their goals,” adds Rosen-Carole. “This means providing excellent medical care for lactating families and creating the conditions where they have the greatest possibility of success.”
FIBF: now that you publicly admit that delayed onset of lactogenesis II is common, will you change your focus to supporting breastfeeding, rather than focusing all your efforts and metrics on exclusive breastfeeding? Will you recognize that mothers who are feeding both breastmilk and formula are still breastfeeding mothers, and they should be supported, not chastised. What about providing equal care and feeding education for families who are formula feeding? Not every parent is able to or wants to breastfeed. Mothers report they have not received appropriate education on how to safely prepare formula, which is unacceptable and dangerous.
BFUSA, You continue to react to public criticism by shifting blame to others. In your last statement you blamed health care professionals for not using their clinical judgment, when your protocols override clinical judgment. Nurses report a climate of fear in using their clinical judgment, social pressure to avoid mentioning formula (or even breast pumping) as an option, and the push towards an adversarial rather than care-taking relationship with patients.
There is no stronger instinct than the maternal drive to feed and protect her infant. Your recommendations put mothers in the impossible position of either ignoring that instinct and letting their babies cry from hunger and thirst or providing supplemental formula milk which you have told them is harmful.You have created a no-win scenario. Mothers have even told us they gave up breastfeeding because they were not told supplementation or mixed feeding were options.
The Fed is Best Foundation, our advocacy teams, and our followers will not tolerate this, no matter how you try to rearrange your policies to sound reasonable, and no matter how many attempts you make to backpedal out of your(link) prior statements. We demand accountability and an apology to all of those who were forced to follow your protocol, and to all of the babies who were left crying or lethargic for food and fluids when breastfeeding was not enough.
HOW YOU CAN SUPPORT FED IS BEST
There are many ways you can support the mission of the Fed is Best Foundation. Please consider contributing in the following ways:
- Join us in any of the Fed is Best volunteer and advocacy, groups. Click here to join our health care professionals group. We have: FIBF Advocacy Group, Research Group, Volunteer Group, Editing Group, Social Media Group, Legal Group, Marketing Group, Perinatal Mental Health Advocacy Group, Private Infant Feeding Support Group, Global Advocacy Group, and Fundraising Group. Please send an email to Jody@fedisbest.org if you are interested in joining any of our volunteer groups.
- If you need infant feeding support, we have a private support group– Join us here.
- If you or your baby were harmed from complications of insufficient breastfeeding please send a message to firstname.lastname@example.org
- Make a donation to the Fed is Best Foundation. We are using funds from donations to cover the cost of our website, our social media ads, our printing and mailing costs to reach health providers and hospitals. We do not accept donations from breast- or formula-feeding companies and 100% of your donations go toward these operational costs. All the work of the Foundation is achieved via the pro bono and volunteer work of its supporters.
- Sign our petition! Help us reach our policymakers, and drive change at a global level. Help us stand up for the lives of millions of infants who deserve a fighting chance. Sign the Fed is Best Petition at Change.org today, and share it with others.
- Share the stories and the message of the Fed is Best Foundation through word-of-mouth, by posting on your social media page and by sending our FREE infant feeding educational resources to expectant moms that you know. Share the Fed is Best campaign letter with everyone you know.
- Write a letter to your health providers and hospitals about the Fed is Best Foundation. Write to them about feeding complications your child may have experienced.
- Print out our letter to obstetric providers and mail them to your local obstetricians, midwives, family practitioners who provide obstetric care and hospitals.
- Write your local elected officials about what is happening to newborn babies in hospitals and ask for the legal protection of newborn babies from underfeeding and of mother’s rights to honest informed consent on the risks of insufficient feeding of breastfed babies.
- Send us your stories. Share with us your successes, your struggles and everything in between. Every story saves another child from experiencing the same and teaches another mom how to safely feed her baby. Every voice contributes to change.
- Send us messages of support. We work every single day to make infant feeding safe and supportive of every mother and child. Your messages of support keep us all going.
- Shop at Amazon Smile and Amazon donates to Fed Is Best Foundation.
Or simply send us a message to find out how you can help make a difference with new ideas!
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Thank you and we look forward to hearing from you!