Fed is Best Foundation receives stories from mothers who have been led to harm their infants in the pursuit of increasing exclusive breastfeeding rates. Learn about the dangers of insufficient feeding in breastfed infants caused by Baby-Friendly Hospital Initiative.
The Letter was from my psychiatrist. It was our way of beating a system that neither of us agreed with, or believed was good for my mental health. It provided protection for me to make decisions that went against the Baby-Friendly Hospital mandates.
The amount of stuff a pregnant woman brings to the hospital for delivery gets progressively smaller, the more children she has. With my first child, I brought three bags; I ended up ignoring 90% of the contents and gave my husband fits when he loaded the car for the ride home. By the time I packed the hospital bag for my third child, everything fit neatly into a small duffel. Even then, I felt like I was overpacking. As long as I had a phone charger, some lip balm, and the Letter, I knew I’d be fine.
The Letter was new; I didn’t have it for my other two birth experiences. It was the result of a long, painful journey, and it embodied all of the knowledge I’d gained over the past several years. It represented a feeling of hope I carried with me as I walked onto the labor and delivery floor at my hospital. Things would be different this time.
On August 11, 2020, Dr. Nicole King, Anesthesiologist, Critical Care Intensivist, Patient Safety Expert and Senior Advisor to the Fed is Best Foundation spoke at the USDA Scientific Report of the 2020 Dietary Guidelines Advisory Committee meeting warning of the dangers and patient rights violations of the Baby-Friendly Hospital Initiative. Watch her address below.
Good afternoon, my name is Nicole King and I am a mother and a physician. As an anesthesiologist and intensive care physician, I am faced with life and death circumstances every day. In no way did I ever consider breastfeeding my child would be as stressful as supporting a COVID patient through their critical illness. Five years ago, I realized how wrong I was.
As a new mother who had had a breast reduction and a physician, I should have known better, but I did not. I fed into the same propaganda, misinformation and fervor around breastfeeding that has grown over the last 30 years as a result of the Baby-Friendly Hospital Initiative and the WHO’s Ten Steps [to Successful Breastfeeding]. I was not informed of its risks and followed the exclusive breastfeeding guidelines, and as a result, my newborn lost excessive weight and was readmitted for dehydration and jaundice.
The current USDA guidelines are filled with the same soft science riddled by confounding factors, that has led to the shaming of women who are unable to exclusively breastfeed for 6 months. The guidelines are an ableist and elitist narrative and read as an invitation to admonish women for failing to produce enough milk for her child. It blatantly ignores research that clearly shows that delayed lactogenesis of mature milk is common, found in up to 40% of first-time mothers and 22% of all mothers, even those who are motivated to exclusively breastfeed. Never mind the 15% of women who are incapable of sustaining breastfeeding past the first month, even with lactation support.
If you are ill and in the hospital, nutritionists are there to calculate the calories needed to feed you in order for you to thrive and recover. Why then are we so easily fooled into thinking an infant who is building muscle, fat and brain cells can be sustained on far less than their caloric needs, purported by the Baby-Friendly policy? If the “biological norm” is put forth as a reason to exclusively breastfeed, then why are exclusively breastfed infants being admitted daily for dehydration, jaundice, and hypoglycemia? Why do we continue to insist on a policy that increases the risk of harm to infants while vilifying supplementation that prevents serious complications? Every day, I protect my patients with medications, machines and nutritional alternatives to overcome so many failures of the “biological norm.” I do this because I too am human and understand that we care and love for each other regardless of our ability to live up to a standard of perfection. Yet we allow babies to become seriously ill by pressuring mothers to achieve this standard of perfection that millions cannot safely achieve. If judicious and humane supplementation is the difference between a hospitalized and a safely breastfed child, then we have failed all mothers and infants in this country by disparaging its use.
The USDA draft policy continues to ignore these realities and thus fails to protect countless infants. National guidelines should never encourage a policy that is directly responsible for the leading cause of rehospitalization of healthy term infants. And most importantly, as a national guideline, it should apply to all mothers, regardless of her ability to breastfeed, across all socioeconomic demographics.
As a mother who followed these guidelines and was led to rehospitalize her own infant, I beg you to consider the plight of all mothers and infants in this country. Every infant deserves to be protected from hospitalization and the complications of an exclusive breastfeeding policy. And their mothers deserve to know that breast milk is but one way to best nourish their children. The USDA is responsible for every child in the US and their policy should reflect this responsibility.
Dr. Nicole King, M.D. is a patient safety expert and Senior Advisor of the Fed is Best Foundation. She is a board-certified anesthesiologist and critical care intensivist.
When my baby was 5 days old, I got a call from the pediatrician we chose before birth. As soon as I answered, she started speaking very fast and explained that Northside Hospital had notified her that one of our son’s Newborn Screening Test results had come back with an abnormal reading; he needed to be evaluated by a doctor urgently, but in the meantime, I needed to be sure to feed him every two hours. I couldn’t even compute all she said, but I explained that we were already in the NICU at Children’s Hospital because of his low body temperature on the first night home from the hospital. We found out that day our son has medium-chain acyl-CoA dehydrogenase deficiency (MCADD).
WHAT IS MEDIUM-CHAIN ACYL-COA DEHYDROGENASE DEFICIENCY (MCADD)?
Medium-Chain Acyl-CoA Dehydrogenase Deficiency, or MCADD, is a rare genetic metabolic condition in which a person has difficulty breaking down fats to use as an energy source while fasting. It is estimated to affect one (1) in every seventeen thousand (17,000) people in the United States. All babies have a newborn screening (NBS) blood test to check for various genetic and metabolic disorders such as MCADD, but it can take five or more days until the results are reported.
Our close call with our baby’s life haunts us, but it propels us to advocate and educate others—about MCADD, yes, but also about the risks of exclusive breastfeeding, before the onset of copious milk production or insufficient colostrum amounts before those crucial Newborn Screening test results are back, which typically takes 5-7 days. We share our story openly and widely, passionately trying to dispel the myths propagated by the “Breast is Best” movement.
The Newborn Weight Loss Tool can provide an answer.
Parents are taught that it’s normal for babies to lose 7–10% of their body weight in the first few days after birth, but is this true? Well, that depends. According to the AAP, a baby who loses more than 7% of his body weight may be losing excessive weight and requires a comprehensive lactation evaluation to rule out delayed onset of copious milk production, primary lactation failure, and/or infant oral anomalies that prevent adequate colostrum/milk transfer.
From the American Academy of Pediatrics HealthyChildren.org website. Breastfed newborns should lose no more than 7 percent of birth weight in the first few days after birth before starting to gain weight again. (Accessed July 16, 2020)
Weight loss has typically been assessed using simple percentages, butnow there is a much more precise and accurate way to track excessive weight loss in newborns and many hospitals, pediatricians, and lactation consultants are adopting this method for greater accuracy in making clinical recommendations. The Newborn Weight Tool, or NEWT, is an online tool, the first of its kind, to help pediatricians determine whether exclusively breastfed newborns have lost too much weight in the first days of life. The tool was developed at Penn State College of Medicine through research conducted jointly with University of California, San Francisco. It was developed using a research sample of hourly birth weights from more than 100,000 breastfed newborns. For a quick synopsis of this tool from the lead investigator and one of developers of the tool, Dr. Ian Paul, watch the video below.
In this video, Dr. Ian Paul, professor of pediatrics and public health sciences at Penn State College of Medicine and pediatrician at Penn State Hershey Children’s Hospital, talks about how NEWT fills an important void. Determining whether an exclusively breastfed newborn is losing excessive weight is important because higher weight loss almost always reflects suboptimal milk intake. It is also associated with increased risk of medical complications such as low blood sugar, jaundice, and dehydration, which can result in the need for medical interventions and future health and developmental problems. This weight-loss tool shows that how quickly babies lose weight is just as important as how much they lose.
I had a beautiful, healthy pregnancy with Bryson, with the help of Clomid (a fertility drug), like my first pregnancy with my daughter. After about 31 hours of induced labor, Bryson was here. Seven pounds, twelve ounces, and seemingly healthy! He latched like a champ immediately, and we had zero complications of any sort while in the hospital. He had wet and dirty diapers and was breastfeeding well, every 2–3 hours. His discharge weight was 7 lbs, and I had a follow-up appointment scheduled for two days later.
NEWT is the first tool that allows pediatric healthcare providers and parents to see how a newborn’s weight during the first days and weeks following childbirth compares with a large sample of newborns, which can help with early identification of weight loss and weight gain issues. Bryson was discharged with a weight loss of 9.7 percent at 36 hours of age. The NEWT graph indicates his weight loss was excessive.
The first two days at home were easy. He was a sleepier baby than my daughter was, and unless wet or hungry, he was calm. I continued to breastfeed him for 20 minutes every three hours as instructed. I did begin to notice that his newborn onesie seemed quite big on him. His wet diapers did slow down on the third day, and he hadn’t pooped since the third day either. At two in the morning on July 29th, at four days postpartum, I tried to breastfeed again, but he was just too sleepy to nurse, and he would not latch no matter how hard I tried. I tried so many times, different ways, different positions. I thought he would eventually latch but he just wanted to sleep. I thought, well I can’t force-feed him, so I’ll try again after he rests a little more. I tried several times after that, and he was just less and less interested. He had started to get pale and lethargic. It was also the day of his two-day post discharge checkup at the hospital, so I decided to take him in early, since I was getting concerned.
During the whole drive there, I felt in my heart that time was of the essence. After the nurse checked him, she said he would have to be admitted, as he didn’t look too good, and his weight had dropped to 6 lbs 9 oz; he had lost over a pound in the four days since his birth. She turned her back, and I noticed he stopped moving. I hesitantly asked, “Is he breathing?” She turned around and yelled, “no!” then fumbled and fumbled to open a plastic bag; I finally screamed at her: “do something!” She picked him up and ran him down the hall.
“Are you breastfeeding or formula feeding?” I cringed as I overheard a complete stranger asking my husband this question while we were shopping for baby clothes. “Formula,” my husband replied. “I can’t believe she asked you that!” I exclaimed as she walked away. “How is that any of her business?” He shrugged and replied, “maybe she’s pregnant and is trying to figure out if she should breastfeed.” “It’s still none of her business,” I said. “If she had asked me, I would have said we’re breastfeeding.”
Yes, that’s right, I would have lied to a random woman because I was afraid she would judge me. Despite my anger at this stranger, however, I wasn’t necessarily worried about what she thought of me; it was about what I thought of me. I felt guilty about formula feeding.
It wasn’t that I didn’t try to breastfeed. It just happened that my nursing journey didn’t exactly work out the way I’d planned, and not a day goes by that I don’t feel bad or like I somehow failed my son for my inability to breastfeed.
Written by an anesthesiologist and Intensivist physician
“The biggest achievement of my life as a physician was stopping my hospital’s Baby-Friendly program after my child was harmed.”
It was September 20th, and we were headed to the hospital for my induction. I was nervous, as any first-time mother would be. I was worried that I was doing the wrong thing, even though I knew the literature, and my physicians supported my decision for an elective induction at 40 weeks. I was already dilated to 4 cm and my baby had dropped way back at 33 weeks. We all thought it would take just a hint of Pitocin, but I labored for 24 hours until my son was born. I was later told that he was born with a compound hand (up by his head), causing the prolonged pushing time and his distress with each contraction.
While pregnant, I had decided to attempt breastfeeding, even though I had had a breast reduction in 2003. I tried to read as much as I could, but honestly, I didn’t have any idea how much information one needed to do something that everyone swore was “best” and “natural.” My baby was born at 4:14 a.m. I thought this would be ideal, because I would have the support and help as I learned how to be a mother, knowing more staff were available during the day. As the first day melted into the first night, nursing became more and more painful, and he needed to feed almost continuously. When he wasn’t feeding, he was either rooting or screaming. Continue reading →
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 studiesthat 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.Continue reading →
There have now beensix studies showing that in some infants, a little bit of supplementation with two teaspoons (10 mL) of formula or donor breast milk after nursing had no effect on long-term breastfeeding. One study showed it prevented hospital readmissions in all of the supplemented newborns. Another showed it actually helped breastfeeding!
Why aren’t medical and lactation professionals recommending this intervention?
Many medical and lactation professionals believe that a tiny amount of formula will contaminate the baby’s gut, causing lifelong health problems. They refuse to admit that formula supplementation can be helpful, and they have baseless concerns that temporary formula supplementation will become routine for all babies. According toBaby-Friendly USA, “donor [breast] milk takes the fight out of this.” What they mean is that the few babies who are born in a hospital with donor milk can be fully fed, while the vast majority of babies who are born in hospitals without donor milk just have to tolerate hunger and thirst so as to avoid a few teaspoons of formula.
Did you know two teaspoons of formula or donor milk has seven calories?
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.Continue reading →