Yellow Alert: When Breastfeeding Businesses Behave Badly

It’s not just formula companies who behave unethically. Sometimes a company who on the surface looks like an ardent breastfeeding supporter can also be known for some pretty dubious marketing behaviour. One of those companies, probably the most famous one, is Medela.

Parents express milk for lots of reasons, many of them will say pumping is absolutely essential to support their breastfeeding relationship and I totally get that. I support parents to exclusively pump or mix pumping/breastfeeding on a regular basis. Lots of us have bought a Medela pump, myself included and so critcising them can feel like a criticism of our choice, especially if we believe using that product saved breastfeeding for us.

Now, some infant feeding training down the line, I wish I’d never bought the round yellow pump everyone loves because:

  • The pump that I chose was an open, single use system so I shouldn’t sell it on.
  • For around the same money I spent on an open system pump, I could have bought a code compliant, closed system double pump.
  • Last but not least, Medela are a WHO code violator so ethically it now makes me feel a bit icky owning one.

Medela being a code-violating company often elicits shock from a community who assumes they promote and protect breastfeeding. Many people, including breastfeeding advocates defend them to the hilt. They make great products! They do lots of research! Surely they aren’t so bad? So why is it that they aren’t the ethical company people think they are?

I’m going to focus on the one area which crops up in my support group on a regular basis. The Calma teat. Medela’s marketing practices around this device have been criticised for years for being code violating and misleading. The below screenshots have been taken from Medela UK website on the 16-05-19. Note multiple claims which break the WHO code of marketing such as “Calma- close to breastfeeding” and “does not interfere with breastfeeding”.

Screenshots taken from Medela UK website

There are many breastfeeding specialists worldwide who dispute this claim including Jack Newman (you can read one of his summaries here). Interestingly I recently found a couple of studies (see screenshots and links below) which show that while marketed as mimicking breastflow, the Calma teat has a comparatively fast flow rate compared to other slow flow teats. Anecdotally, I have myself worked with families who have suffered bottle/flow preferences after using the Calma teat and what makes it worse it usually the family in question believed that buying this expensive system would protect them from this happening. This means folks don’t use techniques such as paced bottle feeding or they give lots and lots of bottles believing it won’t make a difference to their breastfeeding relationship. Sadly, in my experience, sometimes this is just not true.

More study details here:

https://www.michiganspeechhearing.org/docs/Appendix_C.pdf

http://feedingflock.web.unc.edu/files/2014/02/Pados_SNRS_Final1.pdf (Source for right hand image below).

https://www.drbrownsbaby.com/medical/wp-content/uploads/2016/08/DBM-MilkFlowRates-Dayton-Article.pdf (Source for left hand image below).

Medela could be code compliant. They could even sell bottles and be code compliant. I’ve no objection to them being a profitable company or selling matching yellow bottles with Medela on them. I do object to them being sold with statements like “It does not interfere with breastfeeding”, “lets your baby feed the way they learned at the breast”, “makes switching from breast to Calma and back easy” and “Calma- close to breastfeeding”.

I’ve focused on one aspect of their activity here, however, there have been many other incidences of Medela undermining breastfeeding. You can read Baby Milk Action’s summary of their activity here and here you can read about how Medela were removed as a sponsor of an infant feeding conference for WHO code violations.

Just because a company sells products which you think help breastfeeding mothers, doesn’t mean they automatically earn an ethical “white hat” or deserve a free pass. We need to demand better because when families and babies want to pump and feed their milk through another method, they also deserve evidence based and accurate information.

Bottle feeding the breastfed baby- resources

Great article on bottle types for breastfed babies by Rachel O’Brien IBCLC

Best bottle for a breastfed baby? By Philippa Pearson-Glaze

Unicef- responsive bottle feeding

A lactation consultants guide to bottle feeding by Lyndsay Hookaway IBCLC

Video demo of paced bottle feeding by the Breastfeeding Resource Centre

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Responsive Feeding: Why Is It So Difficult?

I’ve just returned from a holiday in Salcombe and aside from the gin and ice-cream, the other thing I found lovely about Salcombe was how many people I saw breastfeeding! I saw breastfeeding on the beach, breastfeeding at the cafes, breastfeeding in beer gardens, breastfeeding at the farm park, breastfeeding at the services. It felt like it was everywhere and it was fantastic.

It was a long time ago now my little girl was a baby but when I saw folks breastfeeding out and about it took me right back.

Let me set the scene. A baby starts crying in a cafe. Parents first start cuddling the baby, jigging about, seeing if baby will settle. They might try to wind the baby. Sometimes baby is passed to someone else instead. A dummy might be offered. Rejected. Offered again. Baby might be taken for a walk around the cafe. A toy might be waved. When the breastfeed begins that comes with moving clothing out of the way, unfastening bras, draping muslins over a disgruntled baby’s head, moving to somewhere more ‘private’. Sound familiar? This was me. It was also something I saw again and again while out and about.

And it isn’t just happening in Salcombe. I sit in support groups weekly and see the same thing. Babies headbutting chests, groping at clothing, quietly agitated. Smaller cues are missed while parents wait for “the demand” of a crying baby.

It’s important for me to say here, this absolutely isn’t a criticism of parents. This is something that has become normal for us all, especially out in public. It is done without question, without thought, it’s just what we have absorbed from the world around us. Breastfeeding in public was for me and still is for many, only done if you absolutely are sure you have to do it. In a culture where breastfeeding is considered time consuming, inconvenient or embarrassing, where it is something that we are told needs a special chair or is supposed to be a ‘special moment to treasure’ this is totally understandable.

I’m not sure the same thing always happens at home in private. I speak to people regularly who say things like “I can’t go out because I know they will need a feed the moment I do” or “I panic if I am out and she needs a feed”. Society is largely to blame for this and it’s a rubbish way to have to feel as a parent. I can’t help but wonder how this impacts on breastfeeding. Like lots of little paper cuts, does it all sometimes build up to a more painful issue? What does it do to milk supply? What does it do to parental confidence?

What is Responsive Feeding?

Responsive feeding is one of the pillars of successful breastfeeding but many parents confuse it with “demand feeding”, a term which is still commonly used. When we say “demand feeding” it feels clear what that means. Responsive feeding doesn’t feel so clear cut. We know a demand is a forceful request, so lots of people think demand feeding is responding to a crying baby. In reality, if we feed responsively, there are lots of subtle cues that come before the cry.

Baby Feeding Cues, Early to Late Stage

Breastfeeding responsively does not mean following a baby’s cues to feed alone either. It also means offering the breast because the parent simply wants to breastfeed or using the breast to comfort and reassure a baby.  

As well as nervousness or reluctance to feed in public, responsive feeding in the UK faces other barriers too. Not long ago our parents were told to feed on a schedule, every 3-4 hours and NEVER to feed for ‘comfort’. “Don’t let baby use you as a dummy” is something else nearly all breastfeeding folks hear. Routine based advice is often passed down today and routine is still something parents often strive for. There are dozens of books and articles out there selling routines to us all. Even up to date advice from the NHS focuses on the baby’s need to breastfeed “8 times or more” every day. While this ‘magic number 8’ may be helpful in some situations, it’s easy to forget the “or more” part of this statement. Sometimes 8 feeds a day becomes a goal, not the minimum.

The reality? Studies following folks feeding responsively tend to find babies breastfeed on average between 8 and 12 times a day, most at the latter end of this range and many breastfeed more than this. My own healthy little chunk breastfed somewhere in the region of 14-16 times a day in the early days. Yes it was exhausting and I worried about it all. the. time. Mostly because people told me that she should be going longer or it meant she wasn’t getting enough. I still remember the sting of another breastfeeding mum asking “Is she really feeding again?!” But if a baby is happy and gaining weight well why do we worry about this? Observational studies of the rural hunter- gatherer tribes show a pattern of very frequent, shorter breastfeeds. There is often a huge difference between what culture says, what routine based books say and what our evolutionary norms suggest.  

So why is responsive feeding important?

Milk Supply: Milk production is tied to frequency of nursing or milk removal.  If milk removal slows down the breast will become fuller. Spacing out feeds and not feeding responsively therefore can send messages to the body that milk production needs to be reduced. This can lead to genuine supply issues.

There needs to be a special mention for the possible impact of reducing night feeds in the early months too. Prolactin levels peak at night so overnight feeds create a fantastic positive feedback loop, helping to build up a really healthy milk supply.

The birthing parent’s health: Following on from the above, problems can occur if breasts become engorged because of infrequent feeding.  Aside from engorgement being uncomfortable, it can sometimes lead on to blocked ducts, mastitis and in extreme cases, breast abscesses and sepsis. Aside from supporting a robust breastmilk supply, breastfeeding responsively is hugely important for health reasons.

Baby’s weight gain: Research in 2006 by Hartmann and Geddes discovered breasts had differing amounts of milk ducts and different ‘storage capacity’ with some people storing 2oz in their breasts and others storing around 20oz!

This means we now understand that breasts have differences when it comes to producing and storing milk. In order to make adequate milk somebody who has a smaller storage capacity may need to feed more frequently than somebody with a larger one. Research has also shown the composition of human milk can vary from person to person and varies in composition according to the time of day or even the weather! Set feeding times cannot take into account all these factors. This means a baby who isn’t being fed responsively may have some issues with weight gain.

Confidence in parenting and in breastfeeding: Feeding responsively, and using the breast not just for ‘nutrition’ but for nurturing has been shown to help some people to feel more confident about parenting because it usually has better outcomes for breastfeeding and often results in calmer babies and less crying time.

Recent research has suggested that people who read and attempt to follow routine led baby care books are at greater risk of feeling depressed, anxious and inadequate compared with people who were not following book routines.

A baby’s latch: When a baby is fed responsively to early cues, they are usually calmer when coming to the breast. Delaying feeds may lead to small babies becoming quite distressed, so when they get to the breast they can be a little ‘disorganised’. Some babies may struggle to latch on, especially if breasts have become engorged. A taut, full breast and a frantic baby can result in shallower attachment. This can cause pain or injury to nipples and result in an unsatisfying breastfeed for the baby.

In conclusion? Not feeding responsively can lead to all sorts of problems. and supporting people to feed responsively is a critical part of supporting breastfeeding folks.

8 Things We Can Do As Helpers To Support Breastfeeding Responsively:

  • Offer help! Support people with practical, around the house stuff.
  • Don’t offer to take baby for a cuddle to see if you can settle them, unless the parents ask you to first.
  • Signpost parents to images about feeding cues such as the one above.
  • Reassure them that feeding in public gets easier with time, talk about how generally people aren’t paying attention! Encourage them to practise in front of a mirror so they can see how little is seen. Tell them they are doing a great job and how lovely it is to see baby so happy when they do feed in public.
  • Sometimes feeding responsively feels hard because of another breastfeeding issue such as pain. If this is the case can you help by signposting to effective, experienced breastfeeding support?
  • If you have breastfed yourself, why not talk about how breastfeeding is so much more than food and that it is impossible to measure and quantify comfort and love? Offer reassurance that this is a very short phase. Talk about how breastfeeding patterns change and become less demanding as babies grow older.
  • Talk about normal sleep development and be honest about how babies sleep when we talk to other people.
  • Encourage people to reflect on whether that feeding app is really helpful. Unless there is a clinical need to monitor feeds, ditching the tracker can really help boost confidence and encourage parents to watch their baby instead.
  • Reassure parents that their instincts are amazing and that they understand their baby far more than granny, a neighbour, an app or any book! Just telling them they are doing a brilliant job can go a long way.
Brilliant video by Swansea University about how to support breastfeeding people

Ultimately, cultural attitudes need to change so breastfeeding folks feel relaxed about this stuff. I long for a day where nobody feels like they need to use delaying tactics to avoid feeding until they absolutely have to. I long for a day when boobing to comfort a crying baby is seen as the norm rather than something to avoid at all costs. I long for a day when breastfeeding is unremarkable. I am currently loving campaigns like #FeedOn by the Association of Breastfeeding Mothers which help get real life breastfeeding seen on a wider stage and I particularly love the images where they show groups of people breastfeeding together rather than it being a solo activity. I love it when I see a parent wandering the supermarket breastfeeding a baby as they go about their day, or feeding in a cafe while chatting with a friend, or feeding in a sling as they attend to another child. That might not feel possible for everyone, but those moments when breastfeeding becomes a little less special and a little more mundane are magic. Every time this happens it is one step towards being that much easier for the next person to breastfeed without apprehension. We can’t change the culture around us overnight but together we can all play our part in making society breastfeeding and responsive feeding friendly.

ABM #FeedOn Campaign Image © RÅN studio

Further reading on responsive feeding

Prof Amy Brown for Kellymom on the importance of responsive feeding

Unicef repsonsive feeding info sheet

Emma Pickett IBCLC and Breastfeeding Counsellor on feeding intervals

Unicef factsheet “building a happy baby”

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Facebook and the Question of Baby Milk

You can’t sell a breast-pump, but you can sell prescription formula.

Facebook doesn’t allow the sale of used breast-pumps which I could understand, if they didn’t allow the sale of second hand Tommee Tippee prep machines, used bottles and teats, discounted first formula or the sale of specialist formulas which are likely to have been obtained on prescription.

Aside from the obvious double standards here I can’t help but worry about the hazards posed to babies who are fed formula milk from these products.

Second hand prep machines can get mouldy, especially if not used correctly, bottle teats can build up bacterial bio-films which are hard to clean (hence teats should be regularly replaced), it is illegal to discount first formula and buying it via the second hand market also opens parents up to other risks. Formula is sold or passed on marketplace which is opened, an obvious contamination risk. Formula milk could also be tampered with, it could be cut with other substances to sell it on for a profit. In some parts of the world we see fake formula. We’ve also seen contaminated batches of milk withdrawn from sale. Any of these things could end up on the second hand market. It is also no small thing to sell on or give away prescription formula. Babies could end up being fed specialist milks inappropriately and also- this is illegal practice. Baby milk is a regulated product for a reason.

The consequences of allowing this to continue could be devastating for families and babies. Time for a re-think?

Further reading:

https://www.bbc.co.uk/news/uk-39278690

https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5a5f913c0d92977380f39cbd/1516212541405/Statement_on_formula_preparation_machines_Nov+2016.pdf

https://static1.squarespace.com/static/5c6bb04a65a70771b7cbc916/t/5ce2e03b9cfe170001660eda/1558372412884/Removing_iFSMP_from_shelves_May19.pdf

https://www.eadt.co.uk/news/framlingham-mum-in-16-000-baby-milk-fraud-given-suspended-jail-sentence-by-ipswich-judge-1-4788496

https://en.wikipedia.org/wiki/2008_Chinese_milk_scandal

https://www.bbc.co.uk/news/business-42348254

https://news.cgtn.com/news/3d3d414d7759444d77457a6333566d54/share_p.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4489094/

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Mummy Wars

Across the great divide of what is “best”, much is lost.

I recently made what I thought was a fairly innocuous post on Facebook, mostly about the marketing practices of big food and formula, along with the cultural assumptions and messages we all absorb from some of our big supermarkets in the UK. I wasn’t really expecting the post to blow up quite the way it did. Among the many who completely related to what I was trying to say, was a core of people for whom the message was triggering. I watched in despair as the conversations went down well trod lines.

I had hate messages sent to me personally. I had public abuse. I was accused of wanting to starve babies. Of wanting formula behind the counter like cigarettes. Of assuming everyone who fed formula was a bad mother. None of which is true. It was hard to know how to react for the best. I’m not sure I made the right call on some occasions, but I’m human after all. So I did my best in the face of a barrage of words and some pretty unkind assumptions about what I was trying to say. About who I was.

Inevitably those same old, tired, lines came out.

“BREAST IS BEST!”

“FED IS BEST!”

“FED IS THE MINIMUM!”

And on, and on, and on. The more I watched, the sadder I felt. The media and invested companies whip feelings up, encourage us to see each other as two camps of people and they profit from it. Nowhere is this polarisation more alive than when it is played out on social media, where there are groups whipping up a storm of anger on both sides.

So this is my appeal.

Please can we stop saying “breast is best”. Breastfeeding is an evolutionary norm, a biological function. It is no more possible for breast to be ‘best’, than it is for sweating to be ‘best’. That doesn’t mean I don’t wholeheartedly believe breastfeeding is significant. It is significant to the health of babies. Equally, it is significant to folks in the UK in ways that often have absolutely nothing to do with ear infections and everything to do with the heart💚. Our wider society and systems should support parents who want to breastfeed. It should just be a normal way to feed a baby. We should acknowledge when it is important to people.

Please can we stop saying “fed is best” to people who are struggling to breastfeed or have decided to stop. It can hold truth for some, but be hurtful and harmful to others. Before making assumptions about how anybody should feel- shouldn’t we ask them? Hold a space for them to tell their story and show kindness rather than judgement? We don’t know their stories. We don’t know their truth. If we are behind a keyboard we probably don’t know them. If they need it, we should support them in a way that is best for them, however that looks. Many parents who decide to use formula often say they felt support drop off a cliff at that point. Many will say a formula company helpline was the only source of support they found. Is this right? Parents need independent, good support however they decide they want to feed their babies. Trust me, as a mum who combine fed, it’s not all on the formula packet.

Please can we stop saying “fed is the minimum” when we respond to somebody who says “fed is best”. Telling a parent who spends so. much. time. preparing formula safely, who may even go hungry to buy formula for their baby, who is up in the middle of the night making bottles, who may have struggled to breastfeed in ways you cannot imagine (or may for other reasons, simply have decided not to), who has good days and bad days and hard days and loves their baby just like you, tellling that parent that what they are doing is “the minimum” is unkind and untrue.

Why are we allowing this illusion of a divide between us when in all likelihood we have more in common than not? In the UK, right at this moment, most mothers will breastfeed and bottle feed at some point.

We do not help ourselves, parents and babies by shouting at each other across a chasm lined with privilege.

Let’s hold a space. Let’s tell our stories. Let’s try to remember we are all flawed humans just trying to do our best in this world. Most of all, let’s support each other on this crazy path that is parenting.

“Kindness begins with the understanding that we all struggle.”Charles Glassman

#breastisnotbest #fedisnotbest #unityisbest #supportisbest #informedisbest

Support for breastfeeding:

National Breastfeeding Helpline

La Leche League

Association of Breastfeeding Mothers

Breastfeeding Network

Unicef (breastfeeding)

Support for bottle-feeding and formula feeding:

Safe formula preparation

Bottle feeding technique

Independent information about formula milk composition

Infant feeding helpline (NCT)

Unicef (bottle-feeding)

Combination feeding