Fear NOT Facts Contained in Baby-Friendly Formula Feeding Waiver Forms

By Christie del Castillo-Hegyi, M.D., Co-Founder of the Fed is Best Foundation

The primary reason why newborns experience starvation-related complications every single day as a result of the Baby-Friendly protocol is because the complications associated with the protocol are hidden from mothers who seek to breastfeed.  The primary objective of the Baby-Friendly Hospital Initiative is high exclusive breastfeeding at discharge.  Unfortunately, because the rates of insufficient breast milk and delayed lactogenesis II are high among mothers, the necessary consequences of hospital policies that seek high EBF at discharge rates are higher starvation-related complications like hyperbilirubinemia, hypernatremia, dehydration and hypoglycemia, all of which can cause newborn brain injury and permanent disability.  Below is an example of the way mothers are made to fear formula supplementation while the risks of NOT supplementing are hidden.  This is a waiver form published on the California Department of Public Health Website to provide an example of a model formula waiver form for hospitals.

Here are examples of FEAR not FACTS contained in formula feeding waiver forms that Baby-Friendly hospitals require moms to sign before they allow a newborn to be formula-fed.

1. FEAR: Supplementation CAUSES delayed milk production.

FACT: The known risk factors for delayed milk production include being a first-time mom, cesarean delivery, flat or inverted nipples, higher BMI > 27, prolonged stage II of delivery (when a mom pushes to deliver), having a large baby, excessive blood loss, being an older mom > 30, PCOS, diabetes, hypothyroidism, insufficient glandular tissue, retained placenta to name a few. While supplementation may be ASSOCIATED with delayed milk production, supplementation is in fact a REFLECTION of the need to supplement a baby who is being underfed due to delayed copious milk production.  (Pediatrics 2003, 112 (3 Pt 1): 607-19)

2. FEAR: Not exclusively breastfeeding puts my child at risk of jaundice.

FACT: Exclusive breastfeeding is among the highest risk factors for excessive jaundice requiring phototherapy admissions according to the American Academy of Pediatrics and 10-18% of exclusively breastfed newborns experience starvation jaundice from insufficient milk intake according to the Academy of Breastfeeding Medicine. Exclusively breastfed newborns are at higher risk of jaundice than supplemented and formula-fed newborns due to the smaller volumes of milk they receive as milk helps the baby pass bilirubin into the stool. In fact one of the ways jaundice is treated and prevented is through supplemental milk feeding.
Pediatrics, July 2004, VOLUME 114 / ISSUE 1, BREASTFEEDING MEDICINE, Volume 5, Number 2, 2010

3. FEAR: Not exclusively breastfeeding will cause my baby to be underfed

FACTS: In the largest studies of supplemented/formula-fed vs. exclusively breastfed healthy, term newborns from a large Baby-Friendly Hospital system, the exclusively breastfed babies lost almost twice as much as the supplemented/formula-fed babies. 10% of vaginally-delivered and 25% of cesarean-delivered EBF newborns lost excessive weight of >10% while NONE of the formula-fed newborns experienced this complication. In fact, exclusive breastfeeding at discharge is associated with an 11-fold higher risk of rehospitalization for dehydration and underfeeding.

Early Weight Loss Nomogram of Formula-Fed Newborns. Hospital Pediatrics May 2015, VOLUME 5 / ISSUE 5

Early Weight Loss Nomogram of Exclusively Breastfed Newborns.  Pediatrics January 2015, VOLUME 135 / ISSUE 1

Rehospitalization for Newborn Dehydration. Arch Pediatr Adolesc Med. 2002;156:155-161

4: FEAR: Supplementing will CAUSE low blood sugar and colostrum protects my baby from it.

FACT: In a study of newborns fed antenatally expressed colostrum along with direct latch feeding of colostrum when compared to those who did not receive expressed colostrum, the babies fed expressed colostrum in fact had higher rates of hypoglycemia requiring admission.  Lancet 2017, 389: 2204-2213

So NO, colostrum does not protect against hypoglycemia. In fact in the most recent study of EBF newborns, 10% had blood glucose levels low enough to increase risk of lower long-term academic achievement. An even older study on low blood sugar in EBF newborns, 53 out of 200 or 26.5% developed low blood sugar within the first 6 hours of life. What protects against hypoglycemia is providing a child their full caloric requirement, which is 100-120 Cal/kg/day to prevent them from running out of caloric reserve.

Study of Asymptomatic Hypoglycemia in Full Term Exclusively Breastfed Neonates in First 48 Hours of Life Journal of Clinical and Diagnostic Research. 2015 Sep, Vol-9(9): SC07-SC10
Association Between Transient Newborn Hypoglycemia and Fourth-Grade Achievement Test Proficiency: A Population-Based Study JAMA Pediatr. 2015;169(10):913-921.
Nutritional management of newborn infants: Practical Guidelines. World J Gastroenterol 2008 October 28; 14(40): 6133-6139      

5. FEAR: Introduction of cow’s milk will lead to cow milk protein allergy.

FACT: In a study of over 13,000 children, earlier introduction within the first 2 weeks of life of cow’s milk REDUCED their risk of cow milk protein allergy by 19-fold.

Early exposure to cow’s milk protein is protective against IgE-mediated cow’s milk protein allergy.  J Allergy Clin Immunol. 2010 Jul;126(1):77-82.e1.

6. FEAR: Exclusive breastfeeding is the ideal way of feeding every baby and there are no risks associated it, only risks of NOT doing it.

FACT: The most significant risks to a newborn’s life and brain come from the fasting conditions imposed by exclusive breastfeeding before full milk production and these risks are hidden from mothers to gain compliance with exclusive breastfeeding.

A review of 116 cases of breastfeeding-associated hypernatremia in rural area of central Turkey. J Trop Pediatr. 2007 Oct;53(5):347-50. Epub 2007 May 12.

Hypernatremic Dehydration in Breastfed Term Infants: Retrospective Evaluation of 159 Cases. Breastfeed Med. 2017 Jan/Feb;12:5-11.

Long-Term Neurodevelopmental Outcome of Neonates with Hypernatremic Dehydration. Breastfeed Med. 2017 Apr;12:163-168

Of Goldilocks and Neonatal Hypernatremia. Academy of Breastfeeding Medicine Blog.

7. FEAR: Just one bottle will ruin my child’s future health.

FACT: Just one bottle can save a child’s life and save them from a lifetime of disability.

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

Letter to doctors and parents about the dangers of insufficient exclusive breastfeeding

#FactsnotFear #FedisBest #BFHIShowMeYourFacts


The Fed is Best Foundation is dedicated to the prevention of newborn and infant starvation from insufficient exclusive breastfeeding. We do so by studying breastfeeding stories sent by mothers and the scientific literature on breastfeeding complications that lead to infant brain injury and death. Since the beginning of our campaign almost two years ago, we have received tens of thousands of newborn and infant starvation stories leading to the complications of hyperbilirubinemia, dehydration, hypernatremia,  hypoglycemia and failure to thrive. These complications occur because the current breastfeeding guidelines have not been studied for safety, operates with little awareness of the caloric and fluid requirements of newborns nor the amount transferred to babies until complications have already occurred. “Just one bottle” can save a child from these tragedies as it is often a mother’s first clue that a child is in fact starving from exclusive breastfeeding.

If your baby is experiencing distress and signs and symptoms of starvation, we encourage you to advocate for your child. We encourage mothers to notify hospital administrators if you are being pressured to avoid supplementation to alleviate your child’s hunger. You have the right to feed your child and your child has the right to be fed. No one but your baby knows how close they are to empty. The only way they can communicate distress is by crying. Listen to your baby and listen to your instincts.

Our message is simple. Feed your baby. Feed them as much as they need to stay safe and satisfied. Only they know what they need.

#FedisBest
Click on the infographic below to print for your reference.

For more information on how to protect your baby from feeding complications due to early exclusive breastfeeding, please read and download the Fed is Best Feeding Plan, a way to communicate your feeding choices to your health care providers.

In addition, please read and download the Fed is Best Weighing Protocol to prevent newborn dehydration and failure to thrive.

Lastly, for more detailed information, please watch our educational videos on Preventing Feeding Complications.

Our full list of parent resources can be found on our Resource Page.

If you wish to help parents learn how to protect their newborns from accidental starvation, please share this story and sign our petition to demand that the CDC, the AAP, the U.S. Surgeon General and the WHO/UNICEF Baby-Friendly Hospital Initiative warn parents about the dangers of newborn and infant starvation from insufficient exclusive breastfeeding. Go to https://fedisbest.org/sign-our-petition/.

 

 

 

Just One Bottle Would Have Prevented My Baby’s Permanent Brain Damage From Hypoglycemia

Written by Holly Lake

I wish I had known about the Fed Is Best Foundation before my 1st son was born. I felt enormous pressure to exclusively breastfeed at my hospital. My son was born at 37 weeks, weighing 5 pounds,13 ounces and he struggled to latch-on and breastfeed at each feeding. When I told the midwife, she came back with a leaflet which described how to hand express. She told me to express 1 mL of colostrum into a syringe and feed that to my baby whenever he struggled to latch.  I asked her if 1 mL was enough and she said it was because his tummy was very small and this amount would be fine until my milk came in. Note: 1 teaspoon equals 5 ml.

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StomachSize

I was discharged hours later not feeling confident my baby was getting enough colostrum.  A midwife came out to see me at home on day 3 because I said I was worried about his feeding. He became extremely yellow (jaundiced), not very responsive (lethargic) and would let out random high pitch screams and would sleep all of the time and never wanted to feed by this time.  He also would have random body spasms which doctors shrugged off as normal baby reflexes (later we found out different).  The midwife said I could wait and see how he did overnight or go to hospital.  I chose to take him to hospital. When arriving, we found that he had lost 12% of his body weight and his blood sugars levels dropped dangerously low to 0.2 mmol/L (4 mg/dL) and was he was jaundiced. Continue reading

My Daughter Starved Because of My Determination to Exclusively Breastfeed and Lack of Knowledge on How to Supplement

By Jamie Nguyen

As new parents, my husband and I relied on professionals: doctors, nurses, lactation consultants to guide us in providing the best care for our newborn. But what happens if most of these professional have bought into a dangerous lie? The lie that all moms, except in very rare cases, are able to produce enough milk for a newborn baby.

After a long unmedicated labor that lasted over 36 hours, my daughter Noemie was born on November 2nd 2016. She was perfectly healthy and weighed 7 lbs 3.5 ozs. My goal was to exclusively breastfeed and the staff at the Baby-Friendly hospital were very supportive. Noemie lost 4% of her weight in the first 24 hours and we were told that it wouldn’t be anything to worry about until it got to more than 7%. However, she had become very fussy and inconsolable, but as we were new parents we just assumed that this was normal baby behavior. Having taken a breastfeeding class, I simply trusted that my body would make enough milk for her. I had been told that not being able to make enough milk was very rare. I asked to see a lactation consultant as I had previously had breast surgery to remove a benign lump from my right breast. The lactation consultant told me that I should have no problem breastfeeding from just my left side. She reassured me that my milk would “come in” sometime over the weekend at day 4 – 5. We were told to get a weight check at the pediatrician’s office on day 4.

Born healthy at 7lbs 3.5 ozs.

Continue reading

Questions to Ask Your Health Providers to See if They Believe that Fed is Best

Mothers have reported feeling unprepared for their birth and postpartum experiences and that their newborns experienced complications from underfeeding due to excessive pressure to exclusively breastfeed.  It is important to know your health providers, their perspectives on infant feeding, supplementation and keeping your baby safe from complications and hospitalization.  These are a list of questions to ask your health provider to see if they and their hospital believe that Fed is Best.

 

What do I do if my milk does not come in and my child is not getting enough milk?

If they are unwilling to discuss this possibility and are unwilling to tell you how to protect your child from complications, then they are not being honest with you and are violating a basic ethical obligation required of all health providers. They should be able to tell you that supplementation with formula or safe, tested donor breast milk can protect your child from complications if your breast milk is not enough.

 

Continue reading

What Should Be The Norm For All: I Was Supported in Supplementing My Twins With Formula

by Kimberly Cartwright

My story is unremarkable but important to tell, because we are often led to believe that it should be remarkably rare.

In 2013 I had my first child, a son.  I researched and knew I wanted to breastfeed him, as breast milk is the recommended food for babies.  There are so many benefits to baby and mother if you nurse, so of course I wanted to try it out.   I have to admit that was a big push to learn all about it and make it work; and we did make breastfeeding work for fourteen months.  Then in 2016 I had my second and third children, my twin daughters.  I knew I wanted to breastfeed again.  The cost benefit for me personally was huge, especially for two babies.  But nursing two babies at once–that’s a lot!  There are a lot of reasons breastfeeding doesn’t work, and you double those when there are two babies.  I was determined to do my best though.

My girls were born at 36 and a half weeks.  Early by the forty week schedule, but basically on time for twins.  (Full term for twins is considered 37 weeks.)  They were right on target for identicals.  I was worried they wouldn’t be able to latch or just wouldn’t nurse well.  Imagine my relief when shortly after both girls were born, they both latched right on and were nursing away.  They knew what to do and we didn’t have any problems.  The only issue was with their blood sugar.  They were still a bit early and of course small.  As per the protocol of the hospital I was at, the girls had to have their blood sugar checked with every feed.  They did pretty well, but their numbers weren’t as high as the doctors and nurses would have liked.  The nurses offered me a simple solution–after I nursed we were to give the girls supplemental formula.  It can take a few days for a mother’s milk to come in.  Yes, my girls were getting colostrum, but we were concerned that I wasn’t able to provide enough in terms of volume for two babies. For the two days we were in the hospital we offered enough formula after each nursing session to keep their blood sugar levels normal and safe.  Once we got the girls home my milk came in. Fast forward thirteen months later and we are still nursing. Continue reading

Letter to doctors and parents about the dangers of insufficient exclusive breastfeeding

(For Spanish version click here)

Dear Colleague and Parent:

My name is Christie del Castillo-Hegyi and I am an emergency physician, former NIH scientist, with a background in newborn brain injury research at Brown University, and mother to a 6-year-old child who is neurologically disabled. I am writing you because my child fell victim to newborn jaundice, hypoglycemia and severe dehydration due to insufficient milk intake from exclusive breastfeeding in the first days of life. As an expectant mom, I read all the guidelines on breastfeeding my first-born child. Unfortunately, following the guidelines and our pediatrician’s advice resulted in my child going 4 days with absolutely no milk intake requiring ICU care. He was subsequently diagnosed with multiple neuro-developmental disabilities.  Being a physician and scientist, I sought out peer-reviewed journals to explain why this happened. I found that there is ample evidence showing the links between neonatal jaundice, dehydration, hypoglycemia and developmental disabilities. I wish to explain to you how I believe this could apply to my son and the many children whose care you are entrusted with. Continue reading