Formula: Sometimes, Medically Necessary

When?

Well, once upon a time, the gene for not being able to produce breastmilk was pretty rare.  If a woman couldn’t produce enough milk, she needed a wet nurse.  Wet nurses were expensive, though.  So if she didn’t have the money, and didn’t have the milk – well, let’s just say the gene wasn’t passed on to the next generation.  Survival of the fittest, did we say?  Perhaps of the richest, who often used a wet nurse even when it wasn’t necessary, to spare Mom the “burden” of breastfeeding.

Over the centuries, many tried and failed to find a substitute for human milk.  The formula we have today is the grandchild of the earliest experiments at alternative feeding; usually these alternative methods resulted in infant mortality within the first year; some from the food itself and some from bad hygiene.  In other words, it is the grandchild of the first non-toxic formula.  Obviously, back then, no one gave formula unless the baby didn’t have a mother, or the mother had not a drop of milk and no one to nurse her baby.

Since the age of barely non-toxic formulas, we’ve come a long way.  We’ve come so far, in fact, that unless you know a person’s medical history, it’s hard to guess which kids were formula fed and which were breastfed.

In other words, formula does a pretty good job of enabling these babies to grow, develop normally, and have a great chance at a good life.

That doesn’t mean, though, that formula is for everybody.  Formula isn’t human milk, and because of that, it wasn’t made for human babies.  However terrific a job it does at compensating for the lack of breastmilk, it still isn’t the ideal baby food.  Formula is like medicine.  In many ways, it IS medicine.  It was made for certain situations, and in those situations, it literally saves thousands, if not millions, of lives.  But just like you don’t give your child penicillin if he doesn’t have an infection, you shouldn’t give your child formula if he doesn’t absolutely need it.  Giving either of them too frequently, and without just cause, can have unwanted results. But, that’s not the topic of this post.

With the advent of good infant formula, a lot of babies survive who wouldn’t have had a chance previously.  With the advent of successful fertility treatments, and good prenatal monitoring, a lot of babies are born who wouldn’t have had a chance to be otherwise.  Combine these factors together, including the fact that if a couple’s infertility is female-factor, the same hormones that made pregnancy difficult may make lactation impossible – and there you have it, growing numbers of mothers and babies who are simply unable to breastfeed.

And – that’s fine.  In fact, it’s great.  It is absolutely terrific that these mothers are able to have babies, and that these babies are able to survive.  It’s a modern-day miracle, and one that we all have to be thankful for.

Again, the problem isn’t formula.  The problem is the abuse of formula. Let’s take a look at some possible contraindications to breastfeeding:

– As usual, mother has no milk.  By no milk I mean that she tried supplements, she tried dietary adjustments, she went to lactation consultants, she nursed and pumped around the clock to raise supply – and no luck.  Nothing doing.  The mother who suffers from this often feels inferior, because she feels betrayed by her body and unable to give her baby its most basic necessity – food.

– The baby who cannot form a vacuum.  This is usually fixable by some surgical procedure (yes, even clipping a tongue is technically a surgical procedure, even more so fixing a cleft palate), and until then, the mother has to stick it out by pumping and/or nursing.  Many mothers, too many, give up prematurely.  (There, but for my research, go I.)

– The mother who is taking a medication that is incompatible with breastfeeding, and there is no breastfeeding-compatible medicine available for her.

– The baby who is lactose intolerant, including lactose from human milk.  Sometimes this is fixable by a change in the mother’s diet.  Sometimes, no matter what the mother eats or doesn’t eat, the baby reacts.

– The baby whose mother got pregnant only a few months postpartum.  While this doesn’t mean that you have to stop nursing, if the baby is less than nine months old, chances are high that supplements will be needed.  Sometimes, the baby will start eating more solids.  Sometimes, if the baby isn’t old enough for solids or refuses, formula will be necessary.  Here I want to add that for the first two or three months of pregnancy, the milk stays suitable for the older baby.  Around week 16-20, it begins to turn into colostrum, and possible supply will decrease.  Again, any breastfeeding is better than none, and even if supplements are necessary for a few months, when the baby is born, the mother can dump the supplements in the trash and nurse tandem.

– The baby whose mother chose a method of birth control that is incompatible with breastfeeding.

– The mother who is hospitalized without being given an opportunity to pump.

– The mother who was given bad advice by medical or lactation “professionals”.

– The baby who has no mother.

There are probably more, but these are the main, basic, categories that come to mind right now.

Let me ask a question: Why aren’t there more banks for human milk?  At the moment, at least in Israel, there is a government-supervised bank, but the milk goes mostly to preemies, gastro-intestinally compromised babies, or babies without a mother.  Why can’t a “normal” baby get donor milk?

Some of you will say that it’s gross.  Well, I have news: Birth is gross.  Changing diapers is gross.  For goodness’ sake, any bodily fluid is gross.  Well, except breastmilk, in my mind; it tastes okay and it’s good for you (I tried a drop of my milk so that I’d know the difference between good milk and sour milk).  What grosses most people out, I think, is the idea of sharing the breastmilk.  But think of it this way: When you need a blood transfusion, do you say, “Ewww, gross, that blood was in someone else’s body?”  Of course not.  So, why is it gross to use donor milk?  As long as the donor is healthy – and if she is willing to feed the milk to her own kid, I think that she can pretty much be trusted – there’s no reason why not.  The only difference between donor milk and the wet nurses of old is that donor milk can be fed to the baby by its parents, while a wet nurse took all the responsibility on herself.

So, now there are Facebook groups and community milk banks.  But they aren’t widely enough spread, they don’t have enough donors, and not enough recipients are aware of them, or willing to use them.  But if formula, in the mind of someone who tried to breastfeed and couldn’t, is a sign of failure, why is donor milk worse?  It’s better – no, you couldn’t breastfeed yourself, but you still made sure that your child got breastmilk.

I think society needs a change of mindset.

Formula is a legitimate choice for those mothers who cannot breastfeed, or whose babies are unable to breastfeed.  Formula is a very, very, good thing, as long as it is not abused.  Those mothers who use it without medical necessity ruin how society views formula for those who have a legitimate need to use it.

Those who need formula should not have to pay the inflated price formula companies ask.  It is not fair, it is not just, to force someone who has no other option to pay an outrageous fee, for that many containers a year.  Formula that is medically necessary should be hugely subsidized.  Formula that is not medically necessary should be off the shelves.

Breastmilk, even donated breastmilk, is better than formula.  Feeding someone else’s breastmilk to your baby is not a sign of failure but a sign of courage and dedication.

Breastfed babies are the norm, not the exception.  Breastfeeding needs to be accepted and encouraged, not something shameful and disgusting.  I am not for a woman exposing her entire front and side on a park bench.  I am for women being able to sit and nurse, modestly and decently (I don’t use a blanket, but between the blouse and the t-shirt underneath, no one sees anything), in public places.  Without worrying if they will be yelled at, without feeling that the whole world is staring at them, without worrying about a smoker coming to sit down next to them (and then they are either stuck second-hand smoking for half an hour, or they have to get up and move in the middle), and without having to walk ten minutes, with a screaming, hungry, baby, to find a place to nurse.

Pumping should be legitimate and supported, especially for working mothers.  It should not be easier for a mother to switch to formula when she goes back to work, especially since, in the long run, it costs us all money.

Society needs a change.  But it won’t happen if we play Ostrich.

 

 

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