Healthy Births, Healthy Moms: Black Maternal Health in America

Part: 2

New York City Pushes Back against Infant Formula

Thursday, August 22, 2013

New York hospitals provide formula to supplement breastfeeding at a rate that puts them among the highest in the nation. The city's Latch On NYC initiative is an attempt to change that.




 

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NEW YORK (WOMENSENEWS)-- While Cherrie Johns was pregnant, she had made up her mind to breastfeed her son. She said she felt good about the hospital she and her boyfriend, Devin Harris, had chosen because of its "pro-breastfeeding" environment.

But when her son Chase was born on Oct. 4, 2012, at Brooklyn's New York Methodist Hospital, things didn't go as the couple had planned. An emergency C-section that required sedation made her extremely groggy after delivery, leaving her unable to initiate bonding and breastfeeding as she had envisioned it.

Johns recalled a nurse bringing Chase to her while she was in a semi-conscious state, saying: "You've got to breastfeed him." But the weary new mom knew she was not up to the task.

"I felt guilty," said Johns about those first hours in New York Methodist Hospital when she opted to give Chase formula. "Your instincts are so strong to give him nutrition . . . so whatever he needs" she wanted him to get, she said.

Now the city has launched a program called Latch On NYC, enthusiastically supported by the city's health-conscious Mayor Michael Bloomberg, with the goal to reduce the number of new mothers who experience the type of disappointment and guilt Johns did by changing the practices and cultures in the city's maternity wards.

Currently there are 29 maternity institutions in the city that have signed up for Latch On NYC, and all of them have discontinued distribution of infant formula company promotional items, Jean Weinberg, a representative with the Health Department's breastfeeding initiative, said in an email interview.

New York Methodist is not among the city hospitals that joined the Latch On NYC initiative launched last year though, and Johns' experience may reflect that. Formula was available in her room, and the new mom turned to it.

The hospital did not return calls for comment.

Varied Supplementation Rates

New York Methodist provided formula supplements to 35.6 percent of its newborn infants. The Lutheran Medical Center, also in Brooklyn, provided formula to 27 percent of itsinfants, while Kings County Hospital in Brooklyn offered formula to 97.6 percent of its newborns, according to 2011 Centers for Disease Control and Prevention (CDC) data.

By comparison, New York University Hospital Center in Manhattan was the best hospital for a breastfeeding mother, with the supplementation rate being 0.9 percent. The worst was Jamaica Hospital Medical Center, in Queens, which had a 99.9 percent supplementation rate, according to the CDC's 2011 data.

With formula supplements ranging so widely in the city, the state had the second highest percentage--33.2 percent--of breastfed infants receiving formula before turning 2 days old in the nation. Only New Jersey had a higher ranking, at 38 percent, according to the CDC's 2011 Breastfeeding Report Card.

But that's changing. While Latch On NYC was underway last year, New York's supplementation rate dropped to 29.7 percent of infants under 2 days old getting formula and New Jersey's rate dropped to 35.5 percent, according to the CDC's 2012 Breastfeeding Report Card. Georgia is now in the No. 2 spot at 34.4 percent.

 

New York Borough Hospital Breastfeeding Rates.
New York Borough Hospital Breastfeeding Rates.

 

Credit: Sources: Baby Friendly USA; U.S. Census Additional Research: Ore Zaccheus, Chikaodili Onyejiukwa and Brittany Edghill

Initially, the Latch On initiative received much negative media attention because the requirements were seen as an infringement on a woman's right to choose, rather than a public health issue and a change in hospital practices. While critics still persist, some hospitals that have not joined the Latch On NYC movement have opted to create their own guidelines for making breastfeeding education and support more available, according to several of their websites.

Latch On's strategies include enforcing the state's regulations not to supplement unless it is medically indicated or at the mother's documented request, tracking formula distribution and ending the practice of giving away free or promotional formula. It also requires the hospitals to prohibit the display and distribution of formula promotional materials in any hospital location.

"It [Latch On NYC] stirred the pot enormously," said Trish MacEnroe, executive director of Baby-Friendly USA, which promotes the internationally recognized 10 Steps to Successful Breastfeeding. The program made hospitals "move [formula] out of plain sight," like they would bandages or medicines, she said.

"Every mother wants to do the best for her baby. It is never our intent to make women feel second-class or bad," MacEnroe said. "It's a lot about informed choice and creating an optimal environment with support . . . in the hospital and beyond."

Staff Support Crucial

For a case like Johns', Dr. Diane Spatz, a professor of perinatal nursing and nutrition at the University of Pennsylvania's School of Nursing, said help from staff is crucial to successful breastfeeding. Spatz has an extensive background in aiding with lactation for high-risk mothers and consults with them, at bedside, to educate them about the lactation process.

"C-section mothers should be supported by their nurses to be able to breastfeed," Spatz said in an email interview. "These moms should have support to hold their infants skin to skin while the nurse is there and with the support of their families."

Spatz explained that the practice of skin-to-skin contact immediately after birth helps with body temperature and blood sugar regulation for the baby.  

"Even if the baby does not latch on and suckle effectively, just the skin contact will increase the mother's prolactin levels," Spatz said. "Higher prolactin levels equals more milk. . . . So even if the baby does not attach to the breast, the skin to skin is still critical."

Spatz added that if the baby can't latch on, "the mother should be assisted to express milk with a hospital-grade electric breast pump. Moms should pump every two to three hours until the baby is effectively breastfeeding. Appropriate supplementation amounts is also critical."

Johns said she was grateful for the option to supplement with formula and felt empowered by having the choice. Yet, she kept trying to breastfeed and said she wasn't fully prepared for the difficulties she faced in those first few weeks after she left the hospital.

"My hospital was very encouraging with breastfeeding," she said. "It was one of the worst experiences" when she couldn't. "They make it out to be the greatest thing ever . . . and when you can't it's the worst feeling. You feel like a failure and you feel like you failed your child."

Emily Taylor, deputy director of the Carolina Global Breastfeeding Institute, based at the University of North Carolina, Chapel Hill, says that in breastfeeding, "women deserve to be empowered . . . especially with decisions that affect their health and the health of their babies."

"If a mom needs formula, by all means give it to her," she said.

She added, however, that the chief complaint she hears from new moms is, "I felt pressured to give my baby formula and felt ashamed and regretted it."

"We need to shift the culture to say breastfeeding support is everybody's job," Taylor said, "not just the lactation consultant."

For More Information:

"New York Borough Hospital Breastfeeding Rates" (Google Document):
https://docs.google.com/spreadsheet/pub?key=0Asj9nM-EqqnFdEFiUkNGNVdEYUE0Q1BHN1FQOUk1a2c&single=true&gid=0&output=html&widget=true
Sources: Baby Friendly USA; U.S. Census Additional Research: Ore Zaccheus, Chikaodili Onyejiukwa and Brittany Edghill

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Why is the first supplement we turn too artificial baby milk? Hospitals should offer banked human milk as a supplement. That way only species specific food will ever be in the baby's gastrointestinal tract cutting way down on the possibility of abnormal gut development.

The article titled “New York City Pushes Back against Infant Formula” serves to reinforce the pressure and guilt that many mothers feel in NYC from the breastfeeding-only trend that is on the rise. In your article a NY was describing the ideals she set out with and the reality following her delivery, unexpected c-section, exhaustion, etc. She states that she didn’t feel that she could nurse, and yet rather than supporting her choice unconditionally to follow her instincts as she says and nourish her baby, the article condemns her choices as “formula was available, so she turned to it”.

While breastfeeding may be ideal, there is no “ivory tower” experience to child birth, every women experiences child birth and the subsequent week of infancy differently. In this time, even the best-intentioned new mother may have a change of heart, or have to face a change in her feeding plan. In this situation, Ms. ____ did just that—adjusted her plan based as was best for her and her baby at the time—and nourished her baby properly. Just as important as educating oneself prior to childbirth and having a feeding plan is this notion: It is okay to change the plan if needed.

We should be supporting all mothers at crucial times, like infancy, helping to ensure that they are given ample amounts of education and training materials, and respecting the decisions that they make on how to feed their baby as best for their family.

We need to find balance in the discussion. Feeding one’s baby should not be all-or-nothing endeavor. Current movements like Latch On and Baby-Friendly are not always mother or family friendly.

While I agree with your premise that breastfeeding support is society’s job not just that of a lactation consultant, let’s try not to forget the rest of our mothers—the over 60%--who formula feed, combination feed, or supplement, and also need support.

Dawn Schuk, MHA
New York City
Maternal Health Professional and Activist

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