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Ann's Blog

When Doing Good Causes Harm ...

Five years ago, Jillian experienced the loss of her newborn. After a rocky start in the hospital, she took her two-day-old, full-term son home and breastfed him frequently. Jillian’s baby ended up on life support 12 hours later and was taken off life support when he was two weeks old. An autopsy determined the cause of death as dehydration.

Devastated by her loss, as any mother would be, Jillian shared her story with the Fed is Best Foundation, an organization founded to prevent newborn starvation due to insufficient exclusive breastfeeding. Jillian’s most poignant statement is: One bottle (of formula) may have saved my baby’s life.

Infant death used to be a fact of life for mothers. A hundred years ago, it was common for mothers to lose multiple children in infancy. One in ten children died before their first birthday. Over the past hundred years, infant mortality rates have decreased by 90%. Today, infant loss is rare. Mothers in our country give birth and expect their baby to survive infancy and live to adulthood. In Jillian’s case, this did not happen.

The Fed is Best Foundation claims that policies supporting exclusive breastfeeding are responsible for withholding food from newborns by encouraging mothers to breastfeed without sufficient standards and research to guide their policies. Could it be that in our efforts to do good, we may actually be causing harm?

Scores of research show that low breastfeeding rates and the introduction of a cow’s milk based formula increase acute and chronic illnesses, and the risk of SIDS. Yet in our zeal to support breastfeeding and discourage the use of formula, we seem to have missed an important piece of the puzzle. Why are we talking about a missing bottle of formula, when we could be providing babies with all the human milk they need?

Human milk is the ideal food for human babies. IF a mother cannot provide her infant with her own milk, there is absolutely no reason why her infant cannot be fed the milk of another mother. No one wants a baby to starve, or even show hunger. Every baby could be sent home from the hospital with a bottle of banked human milk. If a mother feels her baby is hungry, she can feed the donor milk and continue to breastfeed with the intent of bringing in her own supply. If her supply never arrives fully, her baby can continue to receive donor milk in order to grow and thrive.

Jillian was identified in the hospital setting as not having enough milk for her baby. She had numerous red flags indicating that her supply would be low in the early days, and possibly long term. The hospital, in an effort to do the right thing and not expose her baby to cow’s milk, the number one allergen in the United States, did NOT give her baby formula.

A wise hospital policy would be to send every mom home with a bottle of frozen banked donor milk with the following message: if your baby is hungry and not satisfied at your breast, offer a bit of donor milk. Tomorrow, see your doctor and/or an IBCLC to assess your baby's weight and your milk supply. This is not a complicated solution, but it requires a different solution.

There will always be extreme cases, and my sense is that Jillian and her baby are outside the normal parameters. Some babies will lose 10% of their birth weight, but it is very rare for them to end up on life support 12 hours after they go home. However, no infant loss is acceptable to a family who loses their newborn.

As we encourage and support mothers who want to breastfeed, we need to make sure they have the support system they need. This includes access to banked donor milk (as easily as they can access formula) and to insurance coverage for breastfeeding support.

During the Obama administration, mothers with private insurance received access to breastfeeding support via Women's Preventative Services and the Affordable Care Act. This access may now be under threat if the ACA is repealed. Nebraska mothers who ONLY have Medicaid insurance do not currently have coverage of breastfeeding support.

Jillian’s baby might have died in 1900 from dehydration. This should not happen in 2017. We have the means to feed Jillian’s baby human milk, even if it does not all come from Jillian’s body. Making mothers feel that formula is evil is not the answer. If a baby needs food, we need to feed the baby. Every lactation consultant knows this.

It is time to insist that banked donor milk and breastfeeding support be available to all mothers and babies. Community breastfeeding centers can exist in every community. Health care providers can refer moms to needed support in the form of drop in weight checks, breastfeeding information and moms' groups and consultations. When you consider the cost of NOT breastfeeding our children, this support is a bargain. Until all moms have this support, we have no option except to provide formula to hungry babies.

My heart goes out to Jillian and her family. Her loss was devastating. We cannot prevent ALL infant loss, just as we cannot guarantee that ALL babies will breastfeed well or ALL moms will make enough milk. What can we do? Provide the support that mothers need to figure out how to take care of their babies and feed them well. No baby need ever go hungry again.

For additional information on milk supply, weight gain, infant loss, and banked donor milk:

Milk Supply and Weight Gain
Supporting Your Milk Supply
Galactagogues
Donor Milk
Feeding Your Baby Another Mother's Milk
Living through a Loss
Milk Supply After an Infant Loss
Milk Depots