No-BS breastfeeding resources (an ongoing project)

Suppose you're a normal mother-to-be who is planning to breastfeed... or, maybe thinking about it but not committed either way. You're looking forward to doing the sort of things the ordinary, everyday mothers around you do--you're planning a hospital birth with lots of nice drugs, you want to get your baby onto some vague sort of routine so you can plan the day, you'd certainly like baby to start "sleeping through" sooner rather than later, and you'll want to be able to leave your baby with your husband/mother-in-law/babysitter regularly so you can go out. You might go back to work while your child is still young.

Or maybe you're a second-time mother. You tried to breastfeed the first time round--oh, so very, very hard. And it didn't work out. Trouble is, by then you'd already spent months reading all the books and blogs--the ones that told you in no uncertain terms that your formula-fed child was going to be stupid, asthmatic and fat, that you wouldn't "bond" properly, and that anyway this was all your fault because you didn't have an all-natural birth bouncing up and down on a yoga ball, and because you caved and let the nurses take baby to the nursery for a couple of hours because you were too exhausted to see straight. A spiral into gloom, anxiety and hystronic post-partum depression was more or less guaranteed. Now you're girding your loins to try breastfeeding again. But the thought of reading those books again... the ones that were whispering in your ears at 3AM every morning while the tears rolled down your face...

I think you can see why most breastfeeding resources--the books, the blogs, the forums--are problematic for either one of these women. Such resources are heavily oriented towards natural birth, "natural" parenting, and natural just-about-everything-else, and waste no time in telling you about the horrors that await you and your child should you weaken and allow even a single bottle of that ghastly white stuff. And they are full of sloppy science, urban legends and pet theories.

Other books (usually not "breastfeeding books" but rather general how-to-look-after-your baby books) talk about routines and sleeping-through-the-night (almost fanatically, sometimes) yet fail to get the basics right regarding breastfeeding. For example, Gina Ford tells exhausted new mothers to start pumping pretty much from Day 1 in order to stretch out the gaps between feeds. Claire Byam-Cook and Tracy Hogg (the Baby Whisperer) tell women to measure how much milk they are producing by doing a "yield," i.e., pumping and measuring their output, apparently unaware that there are many women--including Yours Truly--who have a good supply but are mediocre at pumping. If I had followed these writers' advice, I would have been convinced that I was starving Little Seal with every feed.

For these reasons, I've decided to start compiling a comprehensive list of breastfeeding resources which I reckon are credible, science-based and reasonably representative of how most of us actually mother. I'll keep updating this as I come across more sources, but this is a start. There's some practical stuff here; there are also discussions of breastfeeding research and politics to muse on, or to wheel in as counter-evidence when someone online is talking bollocks.


Books

Actual breastfeeding books

As I moaned here, it is very hard to find breastfeeding books that don't seem to be written by someone with the shining light of the fanatic in her eyes. Marianne Neifert (in Dr. Mom's Guide to Breastfeeding and Great Expectations: Essential Guide to Breastfeeding advocates for breastfeeding but manages to do so without the harshly judgmental tone of other lactivists. She is almost alone in the breastfeeding book annals in her outspokenness about the difficulties and barriers many breastfeeders experience, and in stating frankly that low supply really exists and is not a myth. Most importantly, her books get all the nuts and bolts right; they are full of great, practical information about how the breasts work, the mechanics of breastfeeding, latching, troubleshooting, pumping and much, much more--everything you'll get in the Womanly Art of Breastfeeding, in short, but without the scaremongering and condescension. By the way, it was Estherar at Mainstream Parenting who first put me onto this book.; check out her review here. 

Solids ("weaning")

Weaning Made Easy is a fun yet evidence-based approach to weaning (=solids introduction, not breastfeeding cessation) which avoids the tedium of the gourmet-icecube tray approach (making overelaborate purees and then spending mealtimes trying to get it all inside the baby) and the pitfalls of the Gill Rapley baby-led weaning method (potential iron/zinc shortages, babies going for months on end without eating anything, neverending mess). It encourages parents to offer different foods in a variety of ways, including soft finger foods and purees of nutritious-yet-hard-to-eat things, based on sound nutritional principles--always with a stress on the individuality of each child and the need for you to feel comfortable with what you are doing. Which, I suspect, is how most people would wean anyway if we didn't have babycare writers telling us how to do it...

Sleep

I have half a dozen infant sleep books on my shelf (ordered by my husband in a fit of Amazon-inspired shopping mania). There they sit, their spines almost uncracked. When it comes to sleep there's only one book I use--Good Night, Sleep Tight by Kim West--and it's never failed me yet. This book (by a sleep specialist who's helped countless families) is moderate, eminently sensible, and flexible enough to work with a whole range of parenting "styles"--while she emphasizes sensible routines and self-soothing, she is also extremely sensitive to the needs and feelings of babies and young kids... and she has a gentler alternative to cry-it-out for those who can't quite face Ferberizing. She also breastfed both her daughters, and that's important because breastfeeding and formula feeding have subtly different dynamics that affect sleeping patterns. A lot of "sleep books".... well, they may give lip service to "bottles/breastfeeds" in their routines, but you can tell it's really formula feeders they have in mind. When a sleep book is written from the point of view of a breastfeeder, it makes the breastfeeding mother feel "This is advice that's realistic for my baby. I feel we have a chance of succeeding with this." With sleep advice it's vital to feel confident that it's achievable and practical for your situation, or you'll never be able to put it into practice. West is not super "into" bedsharing, but discusses it in a sensitive and nuanced manner--the various reasons people bedshare, how to do it safely, how to combine it with learning good sleep habits, and how to transition away from it when the time comes--unlike some other writers who just scold and shame parents who take their babies into bed with them. She is even not-rude about mothers who nurse longer than 12 months (not common in parenting books).

Colic/fussiness
The Happiest Baby on the Block is a mildly attachment parent-y book with some good and practical advice for getting through the colicky weeks months. Generally I'm all for keeping babies on a loose routine, but when colic is wreaking its merry hell, sometimes you just have to grit your teeth and do what's necessary to get through the day. I recommend going straight to the second half of the book and ignoring the first section, which goes on a bit too much about how primitive tribespeople's babies don't have colic because they are carried round all day long (or something).

Other possibilities (recommended by others--I haven't read them)
Milk Memos (nursing and working) sounds like a good and non-judgey read, looking at the Amazon reviews. Child of Mine: Feeding with Love and Good Sense (feeding in general) was recommended by a blog reader. Baby Love (baby's first year) by Robin Barker got a good write-up from several people: "No nonsense; and she calls a poo a poo."


Blogs and websites

Kellymom
Ah yes, Kellymom. I've moaned about Kellymom a few times on this blog (and will be writing a longer post on them in the future). And yet I've sent struggling new mothers off to Kellymom for information several times, and there is presumably a reason for that. Kellymom can be really useful as long as you confine yourself to the “How many wet/dirty diapers should my newborn be producing?” kind of stuff, and bear in mind that this is an attachment parenting promotion site more than anything else. I've compiled a list of pages that I think give decent advice, but with everything that comes from Kellymom keep your skepticism close at hand. If it smells like bullshit, it may well be.  Confirm with other sources if you are not sure!

Low supply
Milk supply worries
Breastfeeding and medications
Weight gain (but see the FFF also here and here for your pinch of skepticism)
Pumping  
Milk supply and the older baby
Newborn basics
 
Much of the other stuff on the site is dodgy, especially the stuff on weaning age, solids/iron and the exaggerated benefits claimed for nursing, especially extended nursing. The forums have some pretty crazy ladies.
PS: Stay away from the sleep advice on that site if you value your sanity.

Science of Mom

A blogger I have a girl-crush on. The post on why breastmilk is so low in iron shreds some myths and misunderstandings about iron and breastmilk. It's refreshing to see a mother who can describe the joys of nursing past a year while questioning some of the dodgy data being used to push this choice onto all mothers. Meanwhile, can breastmilk clear up an eye infection? Possibly yes (admittedly, most of the breastfeeding sites have similar information, but it's nice to see Science of Mom actually confirming this with some data). Other posts cover breastmilk and prematurity, maternal diet and colic, improving milk production in the NICU and more.

Seattle Mama Doc combines evidence-based advice (sleep, breastfeeding, nutrition and more) with a kind and non-judgmental tone that makes for reassuring reading. She's worth a read!

Good Enough Mum

A terrific set of posts from a terrific blogger. She writes about nightweaning for a breastfeeding mother, and breastfeeding the second time around, gives her view on the "Watch your language" thing, and on why brutally unpleasant lactivism is everyone's business, while giving her vision for what positive breastfeeding promotion could look like. She also shreds some of bad science surrounding extended nursing--it's not as beneficial as you think (which doesn't mean you shouldn't do it if you want to)--and takes issue with the idea that a single bottle of formula will ruin your child's "gut" forever.

Fearless Formula Feeder
The majority of breastfeeders will use formula at some point, yet most breastfeeding resources say little about formula other than "Don't" followed by a list of terrifying reasons why--or descriptions of "correct formula preparation" which one suspects have been presented with the deliberate intention of making formula use look as intimidating as possible. That's why the Fearless Formula Feeder site (and upcoming book) can be the breastfeeding mother's friend. Learn the real deal about combo feeding and supplementing, jaundice, the mechanics of formula feeding, spotting formula allergy/intolerance, why you can't use goat's/cow's milk as a formula replacement, growth charts for formula-fed and breastfed babies and much, much more. Suzanne's site is extremely respectful of all safe feeding choices for babies... and what's more, it manages to be scientifically rigorous, well-written and nice--three things that are very hard to combine in online writing.    

Mainstream Parenting, while now defunct, is still a great source of skeptical commentary and mythbusting, some of which covers breastfeeding.


Miscellaneous

Skeptically Speaking's 15-minute podcast on breastfeeding is well worth a listen for an interesting scientific slant on lactation.

Trolls With Wooden Spoons

Trolls (you have to join; oh, and despite the name, the group has nothing to do with the internet phenomenon of "trolling") was created by a bunch of Mothering.com escapees who had become disillusioned with the craziness and horrible moderation on that site. So it's crunchier than I am, yet is also one of the few places where you will seldom get extremist natural-parenting stuff pushed at you; people started this site to get away from all that. And it's full of experienced breastfeeding mothers. There is a refreshing absence of pretension and bullshit on the site. The Woo-Busters page is a good place to get a second opinion on anything which sounds like woo but you are not quite sure!

NB: Avoid Trolls threads on carseat safety or Thanksgiving.

Mammals Suck... Milk! looks at the science of lactation across the animal kingdom, including human beings. Not a "how to breastfeed" blog, certainly, but fascination stuff and great background information.

If this is cost-cutting, just be honest, please

Now here’s an odd bit of news. Britain’s Royal College of Gynecologists (RCOG)—in one of those partnerships that make you go “Huh?”—has teamed up with the National Childbirth Trust (NCT) and the Royal College of Midwives (RCM) to issue "Making sense of commissioning Maternity Services in England – some issues for Clinical Commissioning Groups to consider," a set of guidelines on maternity services to British general practitioners.

British GPs (who are rather like family doctors) are often the first point of contact for pregnant British women and have considerable impact on their choices, so this is important stuff. The guidelines give GPs pointers on how to assist pregnant women, on which sort of birth units they should advise patients to go to, and what sort of questions they should ask of their local hospitals/birth units to make sure they are fit to be recommended.

Much of the guidelines covers matters such as ensuring pregnant women receive medical care early on, looking out for socially vulnerable women etc.—all great stuff and very welcome. But then things get surprising. Credit goes to Pauline Hull of Cesarean Debate who spotted the oddities in the guidelines and posted her own very thorough riposte which can be read in full here. Although the guidelines spend a lot of time talking about “choices,” they do nevertheless seem to be awfully keen that women make the choices that the NCT and RCM consider correct. They encourage GPs to push women towards midwife-led birth units, saying (for example) “There is now a good argument to be made for multiparous women being advised to choose a non-obstetric birth unit” (my emphasis). Most curiously of all, the guidelines also advise GPs that “a 20% rate [of cesarean section] is achievable and sustainable. Every provider unit should have a clear action plan for increasing its normal birth rate…”

I don't want to just repeat everything Hull has already said, so I'd like to focus on the bit about "increasing [the] normal birth rate." On the face of it, that doesn’t sound too scary—after all, nobody would want a woman to have an abnormal birth, surely… who could possibly object to increasing normal birth rates? Well, quite a lot of people, actually. The guidelines define “normal birth” as “without induction, without the use of instruments, not be caesarean section and without general spinal or epidural anesthetic before or during delivery.” The guidelines also advocate raising the vaginal delivery rate, which includes forceps and vacuum. Put this another way—“Every provider unit should have a clear action plan for decreasing its epidural rate, and—if necessary—resorting to more forceps and vacuum deliveries in order to get the cesarean rate down” —and suddenly it all sounds a bit less cozy.

The problem with targets (or, what if you like being abnormal?)
The problem with these kinds of targets is that in practice, they always end up reducing choice and harrying at least some women into birth experiences that they don’t want, simply because of the way target-driven healthcare tends to work—as pointed out by numerous posters on the popular online discussion forum, Mumsnet, where there has been for the most part a pretty angry reaction to these guidelines. In hospitals where VBAC/“normal” birth rates are below target and cesarean sections make up more than 20% of births (i.e. more-or-less all hospitals) medical practitioners are sure to start feeling the hot breath of their organizational managers down the backs of their collars, urging them to “see if they can’t get those rates down a bit,” which in turn will inevitably lead to women who prefer cesarean section being pressured, nagged or tricked into birth styles they don’t want—unwanted VBACs and forceps/vacuum deliveries especially. I’m a strong supporter of the continued availability of VBACs and forceps on delivery wards, as I discussed here—but I wouldn’t want either myself, and I don’t think women should be pressured into them or not given full and unbiased information on their risks, as well as on those of cesarean section. I’m particularly concerned about epidural coverage, because there is convincing evidence that British women are already being subjected to the Great Epidural Bait-And-Switch.

The problem is—and the guidelines themselves sort of admit this, funnily enough, if you read them through—British women are waiting until later and later in life to have their first child; they are heavier than ever at conception; they are gaining more weight during pregnancy and having bigger babies. My concern is that if this reality collides with political pressure to "get those cesarean rates down," we will inevitably see more and more “bad vaginal births”—more long and traumatically painful labors, deep instrumental deliveries, injuries to babies and serious pelvic floor trauma. No wonder Maureen Treadwell of the Birth Trauma Association has expressed her concern about these guidelines.

Strange bedfellows
As Hull says, the Royal College of Gynecologists teaming up with the NCT and RCM is…well… surprising. The NCT is a rather crunchy mothers’ association; and while the RCM is generally respected for its role turning out the National Health Service (NHS)’s own highly-trained midwives it is still heavily biased towards natural—sorry, “normal”— birth. In addition to its Campaign for Normal Birth—see, that word again—the RCM back in 2006 also (as Hull mentions) floated the idea of charging women 500 pounds for “unnecessary epidurals,” but backed down when faced with popular outrage.

But if I thought the RCM and NCT were strange bedfellows for the RCOG, my jaw dropped when I saw page 2 of the 2006 Making Normal Birth A Reality produced the Maternity Care Working Party and included on the RCOG website; “Members supporting the consensus statement” alongside the RCOG include the Independent Midwives Association and the Association of Radical Midwives (do check out the latter’s Facebook page; it makes interesting reading, especially the approving links to Birth Without Fear posts like the one on a "Home Birth of Twins Born Past 41 Weeks, One Footling Breech"?). You do have to ask, what the hell is the RCOG playing at?

Cost-cutting with added crunch
Now, there’s little doubt why the NCT and RCM like the idea of pushing women away from epidurals and c-sections—but it would appear that they’ve thought carefully about how to sell this idea to the NHS:

“Between 2001 and 2010 the national birth rate has increased by 22%... The cost… is set to rise… Commissioners… will need to work in close collaboration with their local maternity providers to ensure that services are both clinically and cost effective.”

The guidelines helpfully remind us that “Every potential cesarean section that is enabled to be a normal birth saves 1,200 pounds in tariff price alone.” Okay, now we're getting down to brass tacks.

In recent years we have seen a lot of initiatives springing up all over the world which dovetail  with earthy-birthy views of how we “should” mother, and which—by a delightful coincidence!—just happen to be marvelous little money-savers as well. There’s the Kick women out of hospital as soon as possible early discharge system which has become popular in places like Australia, and which is great for freeing up beds ensuring mothers and babies can enjoy special bonding time away from the dehumanizing atmosphere of the hospital  (see here and here... ah, and I see the phrase "normalise childbirth" yet again in that last link...). There’s the Baby Friendly Hospital Initiative (BFHI), which has resulted in the compulsory rooming-in policies now found in most Irish hospitals, for example—nice for the hospitals who no longer have to pay for well-baby nurseries or the staff needed for them… let mum do all the work, day and night (if you want to know how the Irish mothers themselves feel about the system, see here).

When I first heard about the BFHI, I remember thinking “So… where’s this going to end? Is the next thing going to be targets for reducing epidural take-up too?” Turns out that wasn’t such a far-fetched idea.

Just be honest, please
If you want to cut costs without howls of protest, there is no better way to do it than to do it in the name of “baby-friendliness,” “normal birth” and so on. It’s clever, really. Anxiety about being a “good” mother and a “real” woman is the 21st century woman’s Achilles’ heel. A woman can’t criticize initiatives which purport to be based on “baby-friendliness” and “normal birth” without leaving herself vulnerable to accusations that she is an abnormal mother who believes in being unfriendly to babies and probably punches kittens and puppies as a hobby in her spare time.

In an age of austerity and rising healthcare costs, governments of nationalized healthcare systems everywhere are looking for ways to limit or ration healthcare services. And you know what? That’s okay. No, honestly, it really is. No healthcare system—especially one funded by taxpayers—can pay for everything for everybody all the time, and sometimes tough choices have to be made. It’s fine to have discussions about whether free formula or cesarean delivery by maternal request (CDMR) or homebirth or whatever is something which taxpayers can’t afford to fund any more when there are other pressing demands on NHS money.

But if we are going to debate cost-cutting, can we please make the debate about cost-cutting, dammit, and not cloak it in sweetly-honeyed words like “natural,” “baby-friendly” and (for the love of God) “normal.” If someone thinks the NHS can’t pay for well-baby nurseries or epidurals, fine—they’re entitled to their opinion; but please just say so frankly. Because then we can all sit down and have an honest debate about where cuts should be made. When a plan to reduce epidural availability or kick women out of hospital early is put in terms of “Oh, but we’re doing this for the babies’ good!” this effectively silences women and shuts down open debate. And that’s just not good for babies, for mothers or for the NHS.

Latch On NYC: Less spin, more details please

"Mayor Bloomberg pushing NYC hospitals to hide baby formula so more new moms will breast-feed" screamed the headline a few days ago. In Mayor Bloomberg's Latch On NTC initiative, we were all told, not only were formula samples to be banned, but formula was now to be hidden away "in out-of-the-way secure storerooms or in locked boxes like those used to dispense and track medications," in order to discourage bottlefeeding, while those wicked mothers who requested bottles anyway were to be subjected to a "talking-to" for each and every bottle they received, by staff who will explain "why they should offer the breast instead." Now, two thoughts ran through my head upon seeing this. The first was, "Wow. This is going to cause a bit of controversy in the mommy blogosphere. I wonder if The Fearless Formula Feeder and Kellymom are onto this yet?" The second was, "Hmm. I notice that article doesn't actually link to an original source. I wonder how much of what's written here is true and how much is spin...?"

Well, the blogosphere got wind of Mayor Bloomberg's little wheeze, and commentary rapidly split down two predictable lines. The "Anti-lactivist camp" (many of the commentators on The Skeptical OB, The Fearless Formula Feeder, Bottle Babies and others) fumed about the proposals. "This is outrageous! It's a woman's right to choose formula--how dare hospitals lecture them about it? Or treat formula as though it was something akin to cigarettes?" The "Lactivist camp" (Kellymom, Best For Babes and all the rest of the crunchosphere--which, by the way, hugely dominate online discourse about motherhood in spite of the beleaguered-minority identity) immediately shot back, "No, this is a great initiative. And the media hasn't reported this properly. Go to the Latch On NYC website--they're not going to lecture women about using formula. And by the way, it's normal hospital practice to lock up items used in the hospital, including food."

Well... with some trepidation, I went to the Latch On NYC website, grimly saying to myself over and over again, "I will not, NOT form an opinion until I have read what the actual initiative itself says...minus the media spin." And even before opening up the Initiative Description and FAQs, it was pretty apparent that there was some serious spin going on. I mean, before long there were news articles appearing which were proclaiming "NYC plans to ban baby formula in hospitals"--absurd.

Well, according to the Initiative Description, the initiative consists of the following:

A call to all NYC maternity hospitals to make a voluntary commitment to support mothers who choose to breastfeed by:
- Enforcing the NYS hospital regulation to not supplement breastfeeding infants with formula
feedings unless medically indicated
- Limiting access to infant formula by hospital staff
- Discontinuing the distribution of promotional or free infant formula
- Prohibiting the display and distribution of infant formula promotional materials in any
hospital location
- A public awareness campaign to promote the health benefits of breast milk, and to inform women of their right to receive education, encouragement and support to breastfeed their babies if they choose to do so.

 So, it looks like the lactivist camp was right to claim that there is some media misreporting--or at least, overextrapolation--going on.
I'll be honest--I think much of what is written here falls into the categories of "Good" or "Neutral." I'm agnostic on ban-the-bags--I don't particularly feel that one's human rights are infringed on by not receiving a freebie; I didn't get free formula from my Japanese hospital, either, and didn't feel deprived. I also feel that ethically speaking, it is questionable for hospitals to receive gifts from commercial organizations because it can create conflicts of interest--although I think that if we are going to ban the bags then to be fair we should be banning all gifts and samples to the hospitals. The "unless medically indicated" bit did make me raise my eyebrows for a second... are they proposing that formula feeding should only be permitted for medical reasons, meaning women should not be permitted to formula feed by choice? But a second glance indicates that this is for breastfed infants only (i.e., you don't give formula to babies whose mothers have chosen breastfeeding, unless there is a medical reason to override her wishes). That's a positive thing.
What about the locking-up of formula? Let's take a look at the FAQ page.

 What does it mean to restrict access to formula?


Restricting access to formula means storing formula away from where it is easily visible and accessible to staff and mothers. Access to formula is restricted by both:


Storing formula in a locked location, such as a storage room, cabinet or an automated medication system or, storing formula in a location outside, but reasonably near, the maternity unit...

  "Locking up" does sound alarming, but I think it's only fair to point out that hospital supplies including sanitary pads, food and just about everything else are usually locked up, recorded and tracked--in part because patients are usually charged for them. Again I think we are seeing a little bit of the phenomenon of journalism that epidemiologist Elizabeth Pisani calls "beating it up." "Making it up" means inventing things up out of thin air. "Beating it up" means presenting true facts in a way which makes them sound as alarming as possible, in order to whip up a bit of hysteria and controversy (which in turn will generate sales and page clicks).

What does concern me a little, is the following sentence:

...Limiting the number of hospital staff with access to formula by implementing a system to identify which hospital member accessed the formula supply; some examples are a log book, a code or a key system.


Restricting access decreases the likelihood that staff will distribute, and inadvertently market, formula.

 It may well do so. It also increases the likelihood that mothers are going to be kept waiting God knows how long while waiting for a bottle to appear (as their newborn screams with hunger) because the reality of hospitals is that there are never enough staff and there are constant complaints from new mothers about lack of support already anyway, and restricting. And then you get mothers inadvertently stretching out the periods between feeds  as long as possible... and pushing the baby to "finish the bottle" when the formula is finally available, in order to avoid the whole process of trying to actually get hold of a bottle of milk. This isn't promoting good feeding practices or responsive parenting. Rule No. 1 = Feed The Baby.

What about the "lecture with every bottle" bit that is allegedly going to form part of Latch On NYC? Here is the relevant section in the FAQ.

What do we tell our staff to do when mothers (families) request infant formula?


While breastfeeding is healthier for both mothers and babies, staff must respect a mother’s infant feeding choice. Educating mothers and families about breastfeeding and providing encouragement and support, both prenatally and after birth, is the best way to ensure breastfeeding success in your hospital.


While in the hospital your staff can:
Assess if breastfeeding is going well and encourage the mother to keep trying.
Provide education and support to mothers who are experiencing difficulties.
If the mother still insists on receiving formula, document it in the chart along with the  reason and distribute only the amount of formula needed for the feeding.
Train staff in breastfeeding support (CLC, IBCLC) who can be available to assist new mothers at all times regardless of day, night or weekends.

 Well, first of all, claims that formula feeding is going to be banned from New York hospitals do indeed appear to be a bit of media hype; Latch On NYC does give at least token support for mothers' choice to formula feed. The bit about training staff in breastfeeding support is great.

But what does "Assess if breastfeeding is going well and encourage the mother to keep trying" actually mean in practice? If the mother says clearly "I don't want to do this any more," is the nurse required to keep urging her to continue? Where do you draw the line between support and nagging? The initiative gives us no clear answers. Certainly, the use of the word "insist" here is deeply problematic. My understanding is that a person only "insists" on doing something when they continue to state their need after having experienced a considerable amount of pressure to do the opposite.

My guess is that what will actually happen is that these ideas will be interpreted in different ways depending on the hospital staff member in question: staff who are basically respectful of all feeding choices will continue to act accordingly, but staff who have the lactofanatic light in their eyes may well see this as a permission slip to harangue mothers more than they are already doing. I don't think it's much of a stretch to imagine this, given that women are already being harassed in "baby friendly hospitals" for choosing to give formula.

Details, details, details
There is a lot about this initiative that is concerning, but we need to make sure that we are focusing on the right things. The initiative doesn't say anything about giving mothers a "talking-to" about using formula, and it certainly doesn't seek to ban formula. But there are some real problems with some of the things it is outlining. What's more, a lot of the initiative is maddeningly vague, and that openness to different interpretations could result in it becoming a green light for bullies.

There has been a lot of negativity about Latch On NYC in the past few days; if its authors want to rescue its credibility, they need to rewrite the thing, spelling out carefully exactly what they are going to do to support breastfeeding and formula feeding mothers and make their lives easier. Otherwise, the only thing Latch On NYC will achieve will be to add an extra keg of dynamite to the mommy wars.