Breastfeeding Expert Dr. Jack Newman on Marketing, Heroin and More

Yesterday I went to hear Dr. Jack Newman at the La Leche League Conference for Breastfeeding Professionals at Tel Hashomer hospital. I have summarized some of the more interesting points below.

In the context of discussing the International WHO Code of Marketing Breastmilk Substitutes (Israel is a signatory), he described the attitudes that formula companies try to foster through their marketing.

THE FOLLOWING ARE FALSEHOODS PERPETUATED IN FORMULA ADVERTISING. DR. NEWMAN’S VIEWS ARE IN PARENTHESES.

  • Breastmilk is best, but formula is almost as good.
  • Actually, formula is better.
  • Breastfeeding is for “infants,” yet formula is necessary through toddlerhood. (Dr. Newman showed a photo of one type marketed for children up to seven years old.)
  • Fathers won’t bond with their babies unless they can feed them..
  • Breastfeeding is difficult, exhausting, and limiting.
  • You can eat only white rice and drink only water until you wean. Forget coffee, alcoholic beverages and cigarettes. (Dr. Newman believes that even the few heroin addicts who choose to breastfeed should be encouraged and not only because breastfeeding will not harm their babies. On the contrary, these babies need breastmilk because they are at high risk for serious medical problems.)
  • Doctors need to be involved in decisions concerning infant feeding. Formula labels read: “Don’t change formulas before consulting with your doctor.” (Unfortunately the extent of most pediatricians’ knowledge of breastfeeding problems is limited to advising mothers to wean. And there are no significant differences between formulas because no one really knows how much of each ingredient should be included.)
  • Bottle-feeding mothers should never be made to feel guilty by being told about risks. But it’s fine to make breastfeeding mothers feel guilty with such statements as, “If you keep breastfeeding your baby won’t gain enough weight and will become brain-damaged.” “If you don’t treat the jaundice with formula (not necessary) your baby will be brain-damaged.”

While discussing marketing, Dr. Newman made the point that mothers who start off breastfeeding are actually likely to spend more on formula than mothers who don’t. How does this work? Mothers who intend to bottlefeed from the start are usually poorer and wean their babies from expensive formula to homogenized milk at an early age, often at three or four months. A better-educated, “well-informed” mother, intending to breastfeed but ending up weaning or supplementing, is more likely to follow the AAP’s recommendation to continue with formula for a full year. Older babies eat larger quantities. This explains why formula companies send more coupons and samples to pregnant women who indicate that they are planning to breastfeed. Over 90% of mothers who start bottlefeeding in the hospital continue with the brand they received there, which is why formula companies do everything they can to get their brand into as many hospitals as they can. They not only donate the formula, they deliver it, “educate” the staff, and take care of disposal and recycling.

Dr. Newman believes that a six-month-old baby on a well-balanced diet of solid food and homogenized milk does not need formula, and that the AAP recommendation to continue with formula for a year was influenced by the formula companies who donate $2 million annually to the medical organization. Similarly, the AAP SIDS Task Force recommended pacifier use for all babies despite relying on one questionable study. The study did not show that sucking on a pacifier was more beneficial than breastfeeding in preventing SIDS. I criticized a different recommendation of the SIDS task force here.

Another lecture focused on encouraging babies who refuse the breast. The most important way of preventing this problem is to encourage mother/baby skin contact from birth. A baby kept on his mother for the first 24 hours will usually crawl to the breast and self-latch, while one forced to eat according to a schedule is more likely to resist. Even in Toronto, where birth is highly medicalized, implementing such a policy was easy. The Israeli health ministry has made moves in this direction but we are nowhere near there yet.. Dr. Newman insisted that educating doctors and health care professionals was not enough; the mothers themselves must demand the changes. I have written here about the Baby Friendly Hospital Initiative. Dr. Newman has travelled all around the world as an advisor for UNICEF, evaluating hospitals according to this standard.

It turns out that Dr. Newman was born in Rehovot, the child of Jewish refugees from Poland. Because none of his father’s family survived, and his mother’s only family was in Toronto, they ended up moving there in 1948. I wonder what Dr. Newman’s career would have been had they stayed here. At any rate, I hope his visit will have an impact on the Israeli attitude toward babies and breastfeeding. Those of you in Israel who are intrigued can hear him tomorrow (Friday), where he will be lecturing to the general public at Sorasky Hall (Nursing School) at Tel Hashomer, from 9:15-13:30. Topics include Bottlefeeding mentality and breastfeeding myths, Breastfeeding and adult health (benefits for mothers and formerly breastfed babies), and Breastfeeding toddlers. Cost is NIS 135 and partners come free. The program can be downloaded here.

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Heroin addicts who become pregnant should immediately seek heroin addiction treatment before anything untoward happens to her or the baby.

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Comments

  1. Isn’t it funny that Israel is home to some of the most top-notch medical facilities and best doctors in the world, yet these silly ideas still persist here.

    I think things are changing for the better, though. More and more mothers are telling the nurses “no bottles” in the hospital, and you can’t walk into a cafe or mall without seeing lots of women breastfeeding their babies.

    So it seems that “l’at, l’at” things are changing- very “l’at”, judging from your post 🙂

  2. mother in israel says:

    Well, the breastfeeding rate has definitely increased a lot here, whether it’s because of Remedia or some other reason. The formula companies have lost a lot of sales! A big part of the problem, though, is an outgrowth of what you wrote–overmedicalization of birth and breastfeeding. Just about every birth intervention impacts breastfeeding negatively.

  3. What he said about formula after 6 months is very interesting. My son stopped nursing at six months, but he ate a really well balanced diet, lots of yogurt, different grains, vegetables, etc. and I never introduced formula. He grew wonderfully.

    My daughter, on the other hand, loves to nurse, and now at 8 1/2 months is still going strong (B”H)

  4. SephardiLady says:

    It is so interesting to see the difference in trends, for lack of a better word, between America and Israel.

    Here I have had nothing but encouragement for nursing. Even when I was told that I needed to supplement with formula because of dehyration, the doctor made sure that I always nursed to empty first before giving the bottle, and the staff made sure to wake me up every two-three hours to nurse, rather than just administering a bottle. And, fortunately, I haven’t had to supplement after about a day and a half.

    My pediatrician office also has a lactation consultant for issues that arise, and the county has lactation consultants and programs to encourage nursing. When I was in the hospital, there was even a nursing class on the basics that was being given to all the mothers there for free.

    And speaking of weight-gain, why is it that people get so caught up on this area? So long as progress is being made, who says your kid needs to be huge? Interestingly enough, in the past few weeks, I believe my toddler has put on a ton of weight. He is obviously going through a growth spur and is “catching up” with the others. Sometimes kids eat little bits, and other times all they do is eat. I tend to be relaxed. A healthy kid won’t starve themselves to death.

  5. Hi MII-
    With each of my boys, our home was flooded with coupons and formula samples. Even in the hospital, we were given bags full of the stuff- all kinds of formula swag. We ended up donating it all, but it was odd to get it all in the first place.

  6. We also got all of the samples and coupons and the like, and I too donated it all. My kids nursed well past a year, so they also never had a drop of formula, but I don’t understand why I see so many people here giving their over ONEs formula??? Esp. when people are stopping nursing at just before one, why start the bottle then? I don’t get it, and I don’t think I saw this in the states, did I????

  7. mother in israel says:

    Thanks to everyone for stopping by!

    OOT–I’m curious whether you had support for your decision to avoid formula, or did you do decide on your own? As for your daughter, I wish you a long, mutually enjoyable breastfeeding relationship.

    SL– I am so glad that you had support and that everything worked out despite the difficulties. I think in the US, as in Israel, so much depends on the staff and the hospital. Over 90% of Israeli mothers leave the hospital breastfeeding, which is more than in the US. They don’t really offer a choice; if you want to bottlefeed you need to request it.
    Now Dr. Newman would probably say that dehydration can be avoided by putting the baby skin-to-skin on the mother from birth and having the two stay together in the hospital, even after a complicated birth. And by observing each pair to see that everything is going well. Babies need small quantities of colostrum in the first days (but as much as they will take of course) and even mothers who later have trouble producing enough milk usually make enough colostrum. If there is a chance that the baby is not getting enough, someone might observe the feeding to make sure the baby is transferring milk (and teach the mother how to tell too), teach the mother how to do breast compression which is a simple method of increasing the flow of milk and the milk supply, and ensure that the baby feeds frequently and not on a schedule.
    Unfortunately sometimes the first sign that breastfeeding is not going well is poor weight gain. It’s easier for health professionals to weigh the baby than to evaluate the breastfeeding. Dr. Newman said repeatedly that doctors are fixated on measurements and they are often not measuring the correct things. (A mother told me today that the hospital told her, based on her baby’s weight, that she needed to nurse every two hours! There is no way to predict such a thing and virtually no babies nurse so regularly.) The question is what to do about poor weight gain–immediately offer formula, or try to fix the breastfeeding. Dr. Newman would start with what I mentioned above and go from there. I am only providing the basics here to show different ways that things can be done.

    Amishav–studies show that women who get formula samples in the hospital are more likely to supplement. And they like to stick with one brand.

    Emah–I don’t know what happens in the US; it could be toddler formula was uncommon in your area but that is definitely the trend there too. I once helped a mother with her newborn, and she mentioned that her 3yo was “addicted” to formula. Another friends’s son had allergies and ate very sparingly, so she felt reassured when he drank it.

  8. SL–what you’re talking about is actually standard in Israel as well. Hospitals here have lactation consultants who give free advice to the mothers, and Israeli mothers are actually much more likely to nurse their children (and keep nursing to and past one year of age) than Americans. The one thing that I didn’t like here was the attitude of some nurses in the baby room at the hospital, who told me that the baby wasn’t gaining weight (as most breast-milk babies don’t for the first couple of days), I should supplement, etc. Still, the doctors and midwives were and are very supportive.

  9. kollelmama says:

    Yeah,what’s up with toddlers on formula?

  10. I basically lied to my doctor, but my Mother in law and my husband agreed that our son was growing and was and is healthy and didn’t need the formula.

    I also do not get giving big kids bottles in general. I have a friend who’s 3 year old had to have major dental work b/c of the bottle of formula at night. It is a terrible habit and they are too full for real food.

  11. mother in israel says:

    Anon–I think that being supportive involves a lot more than telling mothers it’s great. In Tipat Halav they used to tell the mother to give a bottle of formula as soon as the baby didn’t gain well. Now they “support breastfeeding” and they know they aren’t supposed to offer formula so they tell the mother to keep on nursing and come back in a month. By that time the baby is really in bad shape. Supporting breastfeeding involves proper evaluation and giving accurate information, not just lip service and emotional support.

    KM–It’s their way of increasing their business.

    OOT–That story makes me very, very sad. Mothers shouldn’t have to lie to their doctors just because they are not following AAP recommendations.

  12. When my older kids were born, all mothers had to nurse in the hospital; they needed special permission to give bottles of MILK!

    But at theat time we weren’t allowed to nurse them the first 24 hours.

  13. mother in israel says:

    we weren’t allowed to nurse them the first 24 hours.

    Batya–
    Dr. Newman mentioned that several times. He pointed out that nothing terrible happened, yet nowadays, if the baby won’t nurse for the first x number of hours, they start formula instead of giving the baby some time.

  14. I nursed my daughters for 15 and 18 months respectively. They weaned themselves. I lied to the doctor. Each time, he insisted that three months would be enough. I smiled, and continued to nurse.. After that, he’d chart the girls’ growth on the graphs in their records and remind me about how right he’d been about the benefits of formula (since they were doing so well). Again, I’d just smile and continue to do what I thought was right for my girls.

Trackbacks

  1. […] turned down by hospital staff, but may have to pay the price later. Dr. Jack Newman points out that formula companies market to higher-income families, because they are more likely to stick to one brand and use it for longer than poorer families. […]

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