Personal Health

Why Are Hospitals Aggressively Pushing Formula on Newborns?

The trend is spurred on over concern that a baby appears to be dropping weight.

Photo Credit: CroMary

There are a lot of well-intentioned expectant mothers who look forward to breastfeeding, only to be thwarted by the hospital staff when baby is seen losing too much weight. The nursing staff is taught to watch for this, and react accordingly. Far too often new mothers are being swayed from the act of breastfeeding, and persuaded into opting for baby formula, believing it will put on needed weight. However, there’s more to this initial weight loss than the assumption that mother is not supplying enough milk.

Of course there are times when the birth weight is a life-threatening concern, but it seems lately, as suggested by Dr. Jack Newman of the International Breastfeeding Centre in Toronto and the American Academy of Family Physicians (AAFP), the cut off point of weight loss is exaggerated, too cut and dry, and formula is introduced much too often. Many things are out of a mother’s hands these days during the hospital stay, and because it is in the hands of a third party, liability plays a big role in hospital decisions. AAFP discloses that, “despite growing evidence of the health risks of not breastfeeding, physicians . . . do not receive adequate training about supporting breastfeeding.” Therefore, in many hospitals, the decision to continue breastfeeding could be jeopardized.

I can hear the remarks being made as some read this, such as,  “nothing wrong with being cautious,” or, “so what’s so wrong with baby formula?” My response: “Everything.”  

Dr. Jennifer Thomas, a practicing pediatrician has written “Dr. Jen's Guide to Breastfeeding,“ striving to help empower women to succeed with breastfeeding in and out of the hospital. She states, “More than 20% of kids in the U.S. are being supplemented with formula before 2 days. That makes no sense. Surely, our species can do better than having one in five newborns needing supplementation to survive the first 2 days of life.”

The World Health Organization established the Baby-Friendly Hospital initiative to ensure hospitals advocate breastfeeding; the facilities that sign up must abide by strict criteria to create the most helpful atmosphere for mothers to successfully breastfeed, yet there are still too few of them.

Here are the facts and misconceptions derived from various advocate groups that hopefully will help more women understand the natural nurturing fundamentals, and help them follow through with breastfeeding.

1. The 'normal' loss of weight for a baby in the first few days after delivery is up to 10%. Most medical practitioners use the ‘7%’ marker (some even less) as the limiting factor. Therefore, they send up the red flag earlier than necessary, and advocate for formula.  This could mean the difference between the mother fulfilling her plan of breastfeeding or resigning to formula, and could very well be a buffer for medical liability purposes.  If anything, reaching the 7% marker “requires more intensive evaluation of breastfeeding in order to continue it,” states the American Academy of Pediatrics, and not just a cut off point for switching to formula. More medical professionals are now beginning to recognize a need for more intervention to promote breastfeeding, rather than just running for the formula.

2. The way the baby latches onto the breast is one concern to evaluate since it can make a difference in how much milk they get. Other red flags for lactation difficulties are whether the mother takes antidepressants and/or has a disorder called polycystic ovary syndrome (PCOS). These can be addressed prior to birthing.

3. When a mother is given IV fluids prior to birth for epidural or, most commonly, C-section, the baby will actually weigh more because of this fluid; when the fluid is expelled after birth through the baby’s urine, weight drops.  As you can realize, this is not a sign that he/she lost weight; the baby has merely gone back to its original real weight…what it weighed in the womb prior to receiving fluids.

4. Another valid, natural explanation for this weight loss is due to the baby not getting 'milk' the first two days of nursing; they are getting the natural substance called colostrum which turns out to be a very small amount, so there will not be weight gain, there will naturally be weight loss. Not many realize that a baby’s small stomach can only hold a mere teaspoon or two of liquid at a time. This is why two-hour intervals of feeding must take place. This is another natural design of the nurturing process, with weight loss as a normal part of this process.

5. Babies are born with a buffer of fat to help with the stress of labor and the initial weight loss deriving from the fact that milk flow does not begin until about the third day of breastfeeding, after the infusion of colostrum. The fat is there to use up during these times.

6. It is not unusual for baby to stay below his birth weight for 2 weeks.

7. If a mother or baby is given medications at birth, especially pain relievers, then the baby will have less interest in feeding until the effect of this medication has subsided.

8. The baby should be set on mother's breasts right away for skin-to-skin contact and warmth; this is important even if the mother is medicated and drowsy; it’s a natural, necessary part of the process that helps initiate feeding. The baby may take an hour or so to want to suckle, but must lie there continually until it does happen.

9. Breastfed babies will require feeding every 2 hours; Formula babies feed less often because the unnatural cow milk proteins cannot break down as fast as human milk proteins.

Another questionable marker that has developed for formula intervention is low blood sugar. Although in some cases this can be a major concern, the La Leche League International stresses that colostrum is the best regulator for a baby’s blood sugar, and that only comes from breastfeeding. Dr. Jack Newman cites a possible ‘hyper’ concern for the low-blood-sugar threat, and agrees that colostrum is the best blood sugar stabilizer there is for newborns, and formula does not have any benefit. Colostrum is normal while introduction of formula or glucose is counterproductive. He also feels that the marker for blood sugar in newborns keeps changing to absurd levels. A drop in blood sugar right after birth is as normal as the drop in weight.

The medical community is rife with fear tactics imposed on patients, and this most often is generated by their own fear of lawsuits.

As an expectant mother, find out what your hospital’s policies are on breastfeeding, or find a Baby-Friendly Hospital. Not every hospital has the same rules and procedures for breastfeeding, so find the hospital that can accommodate your desires. Discuss your concerns and wishes with your doctor prior to delivery. It’s your birth.  Once comfortable with the facts, women will be better equipped to stand up to their decisions, request testing and evaluations be made, and not let any unwarranted intervention hijack or jeopardize the plan to breastfeed. 

Under normal circumstances, it is not normal or mandatory to turn to formula while in the hospital. Women have been successfully breastfeeding babies since the beginning of human life, and world population is proof.

Linda Bergersen is a board-certified nutrition consultant. She is the author of So, You Think You Eat Healthy? Transition From Bad Foods to Good.