Over
the last few days, I've read several articles about 'Latch on NYC' –
which is about regulating the use of formula in New York hospitals. A
lot of people are up in arms about this, claiming it's about bullying
mothers, undermining their choices, will lead to hungry, screaming
babies, etc, etc.
As
a starting point, here are two of the numerous articles I've seen on
the subject: the most negative and the most positive ones I have come
across.
In
addition, there was a comment on another article (this one, IIRC:
http://www.askmoxie.org/2012/07/the-illusion-of-choice-the-free-market-and-your-boobs/comments/page/2/#comments) suggesting that the restriction of formula in this way was
equivalent to refusing women epidurals until they were at a certain
threshold of pain.
This
analogy is completely flawed. The equivalent would actually be
hospitals not offering epidurals to women who don't ask for them. And
explaining, to women who do, that it is medically healthier not to
have one. And then, if they say they want one anyway, giving it
to them! What currently happens (not every time, nor in every
hospital, but it's not rare by any means) is the equivalent of women
being offered epidurals as soon as they arrive at the hospital, no
matter how well they are tolerating labour and what their birth plan
says, and if the woman declines, saying “Well, I'll get everything
ready for it anyway, for when you change your mind.” Sadly, this often does
happen with epidurals (and c-sections) too, actually.
And
with that....the first metaphorical story of this blog was born:
Imagine you have to go into hospital for minor surgery. There are 2 types of medication you could use – Formex and Boobimel. You are aware you'll need to take the medication once a day for a week. Boobimel is universally acknowledged to be medically the safer, better option: the list of potential side effects from Formex is long and varied (ranging from mild constipation to complications that can prove fatal), but there are no known side effects from Boobimel. Still, no one you know ever had a problem, and most of your friends took Formex because Boobimel was simply not offered at the time they needed it. They are all fine. (Well, some of them have medical issues that are listed as potential side effects of Formex, but LOTS of people have similar medical issues who never took Formex - and no one can know for sure that Formex caused/exacerbated these issues in your friends.) Sure, there's a risk, but it seems to be relatively small.
Boobimel is injected (you hear it's a REALLY BIG needle and hurts like hell), Formex is taken orally and apparently it tastes yummy. You also see adverts for Formex on TV and billboards. Not that they influence you, of course, but you are vaguely aware that if it was that much worse than Boobimel they would be in trouble with trading standards, surely...
You haven't made up your mind as you enter the hospital, but you think you'll probably give the needle a shot (no pun intended). If you don't like it, you can always take Formex for the next 6 days, after all.
Scenario A:
The doctor tells you that you will need to find your own way to the other side of the hospital to be injected with Boobimel, and there is no guarantee that it will actually be ready for you when you get there. There is a Formex packet on the table next to you, and you can take one RIGHT NOW. The doctor looks at their expensive watch, which bears a Formex logo, impatiently, and hands you a glass of water...
Scenario B:
The doctor tells you that Boobimel is the recommended medication for this procedure, and shows you where to go to find it in the hospital. They explain that there might be a bit of a wait, but there is tea and coffee in the waiting room. They answer any questions you have and reassure you that the needle is not as big as you've heard. You ask about Formex, and are told that it is certainly an option, and, so long as you are fully aware of the potential risks involved, they will go and fetch you a Formex, though they are ethically obliged to suggest you at least attempt Boobimel for the first day.
Scenario C:
There is no Boobimel in the hospital, and your surgery has to happen today – you are in a lot of pain! In addition, you are utterly needle-phobic. You have to endure an hour long lecture on why Boobimel is better and are told that the Formex will probably kill you, before the third doctor you speak to reluctantly allows you to have a packet of Formex pills, and walks out in disgust, without telling you how many to take.
Imagine you have to go into hospital for minor surgery. There are 2 types of medication you could use – Formex and Boobimel. You are aware you'll need to take the medication once a day for a week. Boobimel is universally acknowledged to be medically the safer, better option: the list of potential side effects from Formex is long and varied (ranging from mild constipation to complications that can prove fatal), but there are no known side effects from Boobimel. Still, no one you know ever had a problem, and most of your friends took Formex because Boobimel was simply not offered at the time they needed it. They are all fine. (Well, some of them have medical issues that are listed as potential side effects of Formex, but LOTS of people have similar medical issues who never took Formex - and no one can know for sure that Formex caused/exacerbated these issues in your friends.) Sure, there's a risk, but it seems to be relatively small.
Boobimel is injected (you hear it's a REALLY BIG needle and hurts like hell), Formex is taken orally and apparently it tastes yummy. You also see adverts for Formex on TV and billboards. Not that they influence you, of course, but you are vaguely aware that if it was that much worse than Boobimel they would be in trouble with trading standards, surely...
You haven't made up your mind as you enter the hospital, but you think you'll probably give the needle a shot (no pun intended). If you don't like it, you can always take Formex for the next 6 days, after all.
Scenario A:
The doctor tells you that you will need to find your own way to the other side of the hospital to be injected with Boobimel, and there is no guarantee that it will actually be ready for you when you get there. There is a Formex packet on the table next to you, and you can take one RIGHT NOW. The doctor looks at their expensive watch, which bears a Formex logo, impatiently, and hands you a glass of water...
Scenario B:
The doctor tells you that Boobimel is the recommended medication for this procedure, and shows you where to go to find it in the hospital. They explain that there might be a bit of a wait, but there is tea and coffee in the waiting room. They answer any questions you have and reassure you that the needle is not as big as you've heard. You ask about Formex, and are told that it is certainly an option, and, so long as you are fully aware of the potential risks involved, they will go and fetch you a Formex, though they are ethically obliged to suggest you at least attempt Boobimel for the first day.
Scenario C:
There is no Boobimel in the hospital, and your surgery has to happen today – you are in a lot of pain! In addition, you are utterly needle-phobic. You have to endure an hour long lecture on why Boobimel is better and are told that the Formex will probably kill you, before the third doctor you speak to reluctantly allows you to have a packet of Formex pills, and walks out in disgust, without telling you how many to take.
No one, absolutely NO ONE, is advocating option C. The current initiative is about replacing option A with option B. (In the circumstances described in Scenario C, the doctors should be apologetic, and sympathetic, and recommend, in your case, going with the Formex, although if you really want to wait til the next day in the hope some Boobimel will arrive in hospital, that's your choice, they will keep monitoring your condition and inform you if anything changes.)
Sure, post-natally, you
are often scared, in pain, suffering, and don't WANT to be reminded
that it isn't a good idea to supplement when that seems so attractive
when your newborn is struggling to latch. But when I was in labour,
scared, in pain, and told my baby was not coping very well, I signed
the c-section consent form. I would have let them cut me open if they believed it
was MEDICALLY a good idea. Heck, I'd have let them cut off my arms
and legs at that point if they had told me it would help! I didn't
have a c-section, because I didn't need one in the end. I don't think
it would have been appropriate for them to accept my hasty signature
(while in pain and panicking) as my 'choice', despite the lack of
medical necessity, since my birth plan, into which I'd put a lot of
thought, clearly stated that I wanted to avoid interventions if
possible.
These sort of initiatives are about encouraging informed choice, not reducing people's choices, but expanding it. If an infant is supplemented with formula, especially in the early days, that mother's milk supply is damaged, sometimes irreparably. This reduces her ability to choose. If a mother is given accurate information - even if that information is unwelcome at the time - it has no impact on her ability to make a choice.
But I'm about to go off at a tangent, so I'll leave the matter of choice until next time...
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