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

New York delivers for midwives

Last Friday, New York's Gov. David Paterson signed into law A8117b-S5007a, the so-called Midwifery Modernization Act, which removes the requirement for midwives to obtain a written practice agreement from a physician or hospital to practice in New York State. The bill will take effect in three months.

Paterson's signature was by no means a sure thing — the Democratic governor, who is not seeking re-election in the fall, vetoed thousands of bills this summer, and he waited until the very last possible day to sign the midwifery bill.

Not only that, but the American Congress of Obstetricians and Gynecologists, the new political arm of the American College of Obstetricians and Gynecologists, lobbied against the legislation. The group argued that it would make midwife-assisted birth less safe, as midwives who did not have formal relationships with doctors might not be able to access medical care in an emergency.Pregnant Graffiti WPAs have been a condition of practice for midwives in New York since 1992.

But old certitudes and worst-case-scenarios fell flat in Albany this summer.

The closing of St. Vincent's Hospital in New York City last spring created a crisis for those relatively few women seeking home birth with midwives, and provided an object lesson in the difficulties the requirement for a written practice agreement could create. By June, seven midwives who had had WPAs with St. Vincent's were still scrambling to find doctors willing and/or able to formally partner with them, and hundreds of mothers who had been planning to deliver at home were in a state of limbo.

Beyond the immediate concerns, though, the ease with which the bills sailed through the New York legislature — the vote was unanimous in the Senate — suggests that midwifery has attained a mature level of acceptance in New York, which has perhaps 900 midwives, more than any other state.

Assemblywoman Amy Paulin, for example, one of the bill's sponsors, had her children with midwives, including two home births.

Groups that represent midwives emerged as effective lobbyists for the bill, mustering thousands of calls, emails and signatures on petitions.

Meanwhile, ACOG's efforts were notable for gaffes like a quote in the New York Times from Donna Montalto,  executive director of ACOG's New York division, who said physicians might balk at providing emergency care without a WPA.

“What obstetrician who has never seen the patient, doesn’t know the midwife, and happens to be at home at their son’s baseball game is going to say, ‘Sure, I’ll come in and take care of your patient,’?” Montalto said.

Perhaps most importantly, the new act affirms the view that birth is a natural event, and not necessarily a medical one. New York legislators have given midwives a vote of confidence, one that could portend a significant shift in attitudes about childbirth.

"Pregnant Graffiti" by Petteri Sulonen