There was no press release, no formal announcement. Without fanfare the mayor of New York launched a $2 million initiative this spring to encourage breastfeeding, first by banning the maternity ward ritual of handing out free baby formula samples to mothers. I only caught wind of the plan because Jennifer Zajfe got offended by it.
"Hospitals are no longer mom-friendly," Zajfe proclaims in a recent New York Times op-ed. After her cesarean, the free samples were a "godsend," she writes, and furthermore, "neither the government nor the medical establishment should try to manipulate a woman's decision" to bottle or breastfeed by withholding a formula company's "gift."
But gifting isn't what's really going on here. Bloomberg is right: breast is best. Nothing in a can comes close -- the research is very clear on that. And if the baby doesn't "latch" early on, the milk won't keep coming. The CDC calls this a "time sensitive" relationship.
Formula companies make their profit by interrupting, coming between baby and breast. And only in the U.S. do we invite these companies into the hospital, right up to the postpartum ward, directly onto woman's laps, where we lay a "gift" bag full of freebies, coupons, and glossy literature, all stamped with the company logo. The heaviest thing in the tote is of course a six-pack of formula -- just enough so that when baby finishes it, mom's milk has dried up.
That's why UNICEF and the World Health Organization require that "Baby Friendly" hospitals and birth centers have zero tolerance for this marketing tactic. Anne Merewood, a professor at Boston University Medical School and co-chair of the Ban the Bags campaign explains: "The formula companies are doing two things: undermining breastfeeding and trying to promote their brand," and doing this in a hospital lends the product medical validity. "It's just unethical," she says.
Women who can't or choose not to breastfeed, rest assured: "There will always be formula in the hospitals," a spokeswoman at the NYC department of health told me. But Bloomberg's plan is to give out freebies like ice packs (to keep pumped milk cold) rather than corporate swag. Otherwise, public health agencies, which recommend that women breastfeed exclusively for the first six months, and hospitals are working at cross-purposes.
Women like Jennifer Zajfe are sick of these mixed messages, and they're sick of being branded "lazy" for bottle-feeding. "I fully expected to breast-feed my baby," writes Zajfe, "but, as I soon discovered, Caesarean deliveries often delay milk production. By Day 4 in the hospital, I was a wreck from the pain of the C-section and from trying to nurse with cracked, bleeding nipples that weren't producing milk....Mine is just one story. With Caesarean rates skyrocketing in New York City (some hospitals have a nearly 40 percent rate of Caesarean delivery), formula often becomes a necessary part of the equation."
Here's the bigger problem: the C-section rate. Surgery not only delays mother's milk, but mother and baby are usually separated for several hours postpartum. The WHO and UNICEF recommend immediate skin-to-skin contact and breastfeeding initiation within the first *half hour* following birth, and the most common reason it doesn't happen is the cesarean. Even after a simple vaginal delivery, babies are typically swooshed away from their mothers, wrapped up in blankets, and presented like a bottle of wine at the bedside dozens of minutes after the birth. With a cesarean, it's often three hours before mother and baby reunite.
The fact is that typical American maternity care does not promote breastfeeding (I explore this in my new book, Pushed. As a result, only 55 hospitals nationwide meet the international Baby-Friendly standard -- as opposed to 15,000 centers across the globe -- and not one is in the New York metro area.
I don't blame Zajfe for defending her choice and demanding her free formula. These public health initiatives annoyingly put the onus entirely on women to get their act together -- Bloomberg's $4.5 million umbrella plan is called the Take Good Care of Your Baby campaign, as if women need to be told. Bloomberg could throw another few mil at a Take Better Care of Our Mothers campaign to promote best practices on maternity wards. For now, though, the ice packs are a good start.