On mandatory breastfeeding

Many people mocked supermodel Gisele Bundchen as a "boob" and a "twit" a couple of years ago when she said the law should require mothers to breastfeed for at least six months. It turns out Bundchen may just have been a little ahead of her time.

As of this summer, hospitals in New York City will no longer make formula available to new mothers and babies unless it is medically indicated, or promote its use in any way. "Latch On NYC" is an initiative of the city's mayor, Michael Bloomberg.

"Motherhood" by Mary Cassatt

Studies have been piling up in recent years that show that breast-fed babies  do better in a number of ways than bottle-fed babies. Still, fewer than one-third of babies are consuming only breast milk at 3 months, and nearly four-fifths of babies have stopped breastfeeding altogether before the recommended minimum of one year. 

And as Linda Lowen wrote recently on About.com,

Part of the problem is that we like our swag -- our goodie bags packed with toys and samples and coupons. Hospitals give these out as a matter of course, and as new moms we're eager for it.

The swag started with the formula companies. And they knew exactly what they were doing. They were hooking women at an emotional and vulnerable time, and from there they reeled us in.

Taking the free samples of formula away from new moms in hospitals protects them from the manufacturers who make it so easy to start a baby off on formula, rather than on the breast, Lowen wrote.

But even some breastfeeding proponents are protesting the new methods for giving breast-feeding a leg up in the nursery. Some women say mothers are already feeling the effects of Latch On NYC, which will go into effect Sept. 3.

New NYC mom Jacoba Urist wrote in a Wall Street Journal blog about her experience trying to have her baby fed with formula at the New York University Medical Center, where she had given birth, so she herself could sleep through the night. Nurses twice said they couldn't find any formula, and brought Urist her baby in the middle of the night to breastfeed, she wrote.

After Sept. 3, lack of cooperation, if such it was among those nurses, will turn to rules in NYC. "With each formula bottle a mother requests, she’ll get a lactation lecture about why she should use breast milk instead," Urist writes of Latch On NYC. She supports breastfeeding in general and does it herself, but thinks the new rules themselves will "prey on women in the days (sometimes hours) after they deliver a baby."

Kara Spak, a new mother and my former colleague at the Chicago Sun-Times, made an especially compelling case for leaving formula-feeding moms in peace, in a recent commentary about Latch On NYC in the Sun-Times.

Spak, who is perhaps best known nationally for winning more than $85,000 as a contestant on Jeopardy in 2010, wrote that she intended to breastfeed, but her baby wasn't thriving on breast milk. Ultimately, she had to choose between her baby's health and the breast-feeding ideal. She began feeding her new daughter formula, and continues to do so.

After that traumatic beginning, when Spak talked with her friends with babies, all of whom were committed breast-feeders, it turned out that all of them had had problems nursing, she said.

And that's the travesty here, or one of them, anyway. As Alissa Quart reported in her recent New York Times op-ed piece, "The Milk Wars,"

For most women, there is little institutional support for breast-feeding. According to the Bureau of Labor Statistics, only 11 percent of private-sector workers get paid family leave through their employers. Once mothers go back to work, there are few places where they can pump milk for later use.

Jane Brody's NYT column in response to Quart's piece, "The Ideal and the Real of Breastfeeding," gave readers a look at this longtime health writer's own rocky experience with nursing many years ago, plus a survey of studies and anecdotal evidence that makes it clear that, while breast might be best, it isn't for everyone.

On a more positive note, this year's "Big Latch-On," completed just this weekend, attracted 8,862 nursing babies (and their moms) in 23 countries, a new record.

And check out Birth Story's previous posts on breastfeeding.

Image: Motherhood by Mary Cassatt

Colbert: Free birth control = havoc

Free birth-control and breast pumps? Government subsidies for domestic-abuse interventions? Some people have no trouble conjuring the moral slide those new policies will precipitate.

Modeled on recommendations by the independent Institute of Medicine and announced by the U. S. Dept. of Health and Human Services this week, the new provisions set off a firestorm of protest in some conservative circles, including this diatribe from Stephen Colbert's conservative  character on Comedy Central.

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Storytime?

Amber Strocel is one of my favorite bloggers. A Vancouver, B.C. "crunchy granola mom" (and engineer), Strocel writes with equal aplomb about the pleasures of domesticity and more serious issues like Internet privacy.

Strocel also writes a good bit about childbirth, and one recent post got me thinking. In “Scare Tactics,” Strocel considers which kinds of stories about birth and breastfeeding women should share, in particular with pregnant women.

As anyone who has ever been pregnant knows, that bump is a powerful magnet for women who had a 78-hour labor, or whatever, and believe you need to hear a blow-by-blow description, complete with sound effects.Pregnant Graffiti

“I don’t see much value in sharing horror stories,” Strocel wrote, adding that during a discussion she shared on Twitter, others had disagreed, saying they thought “negative stories can prepare women” for the possibility of problems with birth or breastfeeding.

Strocel relates that during the birth of her first child, precipitated at 34 weeks by an infection, she experienced severe hemorrhaging, which required surgery and a blood transfusion.

“I was actually not all that afraid of labour when I was pregnant the first time around… Being armed with someone else’s story of severe blood loss wouldn’t have changed anything for me,” she writes. “Thinking about it, I believe there’s a difference between sharing a horror story that scares someone out of her pants, and useful information that you can use to avoid problems.”

Strocel offers an example of the latter: "If I had a very negative experience with a health care provider, I might share that with someone who was considering seeing the provider."

I agree that would be useful information, but the key would be to catch a woman before she had committed to that provider. By the time other people know a woman is pregnant, she has usually settled on a birth attendant.

In fact, I’m not sure any birth stories have utility for a pregnant woman. Let's think about a really positive one. Would hearing about supermodel Gisele Bundchen’s painless water birth really be encouraging to the average mortal? No pressure, girlfriend, but Gisele had zero pain.

I suspect one reason why people deluge pregnant women with birth stories is that we assume they have some interest in a topic we don't actually get to talk about that much.

The birth story occupies a place very near the heart of the narrative of most mothers’ lives. I have two birth stories myself. One tells of a vaginal delivery in a hospital that required foiling an obnoxious resident itching to perform a Caesarean-section; the other is a near-miraculous survival story.

I hardly ever tell these stories out loud. They are great stories, full of colorful characters, conflict and drama but, practically speaking, who can I press them on? The people who are willing to listen to me use words like “vagina” and “transfusion” do not include, for example, my brother-in-law.

As I think about these stories, though, it occurs to me that even though the near-death experience is more dramatic, the birth of my first daughter is more satisfying, more reassuring, more the kind of narrative prospective parents are looking for: A family overcomes obstacles to have the experience it was hoping for (more or less). It was certainly more pleasant to live through.

I'm not sure it is the more helpful of the two stories. Knowing what it takes to live through a calamity — in our case, speedy access to a competent surgeon and anesthesiologist, and plenty of blood — seems to me to be extremely useful information.

But perhaps the stories we mothers like best are the ones where the fair damsel saves herself.

The latest edition of doctors’ book on birth

Often, the annual meeting of a medical group produces a flurry of scientific papers, but the meeting of the American College of Obstetricians and Gynecologists seems more like, say, a bunch of writers  getting together. (I attended the 2009 meeting in Chicago.) As a cohort, OB-GYNs seem to want to find out about the newest approaches, tools and techniques they might put to use in their practices, and perhaps exchange some stories from the trenches as well.

Happy babyBut here's something new for consumers from ACOG, which held its annual meeting in San Francisco this week. The fifth edition of Your Pregnancy and Childbirth: Month to Month was unveiled, along with a new companion website,  www.yourpregnancyandchildbirth.com.

While there are many pregnancy books, this one is "unique in the extent of the medical detail that it covers about all aspects of pregnancy, yet it is designed as an easy-to-read, helpful reference for all of those questions that inevitably pop up," said Hal Lawrence, MD, The College's vice president of practice activities in a press release on the ACOG website.

The latest edition of the book has a new chapter that addresses obesity and eating disorders, another devoted to diabetes during pregnancy, and a third covering other chronic diseases like hypertension, heart disease, celiac disease, lupus, and physical and mental disabilities.

"The majority of women do not experience severe complications, but we felt it was important to give a thorough overview so women will know if something's wrong and when to call a doctor," Dr. Lawrence said.

Another new chapter covers feeding the baby, and includes advice on both breastfeeding and the use of formula.

A change of course

Robbie and Susan Goodrich had been married three years when she died of an amniotic fluid embolism during the birth of her son Charles Moses last year.

The couple had been full of plans. Robbie would ramp up his career so that Susan could scale hers back to spend more time with the children. Now he's going back to work after a year's leave of absence, as a single father.

Moses Goodrich

Moses Goodrich

During a phone interview, Goodrich said, "I'm throwing myself into my work, so I can go home and be with the kids."

Goodrich said, "I have to re-invent myself as a widower, with two kids in diapers. I'll do what has to be done to put bread on the table, but it's just me now.

"I know that the process isn't over. I have to do everything that has to be done emotionally to deal with the loss of Susan. I have to accept that it won't be the same me or the same life," he said.

On Dec. 6, Moses took his first steps.

On Dec. 10, the family celebrated Susan's birthday the way they usually had. They cut down a tree for Christmas, went snowshoeing, made Susan's favorite tapas.

"We celebrate her birthday. Her death day coincides with Moses' birthday but we celebrate Moses and the life that she gave on that day.  We celebrate who she was and how she lived and not the accident of her death," Goodrich said. "Though that's easier to say than to do."

Photo courtesy of Robbie Goodrich