Hospital keepsake for newborn babies is an effective marketing tool for infant formula companies

From "A Mother is Born" blog post
What Not to Say To A New Mother: Hospital Edition
by Meredith Fein Lichtenberg
 

It's important to see the lengths infant formula companies go to in order to market breastmilk substitutes.

Take a look at this bassinet card Meredith Fein Lichtenberg writes about in her recent post "What Not to Say To a Mother: Hospital Edition" and making the rounds on Facebook thanks to Unlatched.

These bassinet cards are printed up by the hundreds of thousands and given free of charge to hospitals because infant formula makers know it keeps hospitals from having to spend precious dollars to print out their own ID cards. The front of the card is the standard ID card for babies in bassinets - the one that has the baby's name, date and time of birth, and weight. The card is what most parents take home with them as the only keepsake they have with that information. I remember being warned about these cards when I was first in hospital 30 years ago, when the concept of rooming in was new and babies were routinely kept in the nursery overnight and fed formula by the night nurses so new moms could sleep. Breastfeeding moms were advised to take in a marker and write "breastfed baby only, no formula!" on the cards.

The cards are clearly an effective marketing tool if they are still being used all these years later.

The card above is designed to convince mothers to keep feeding their babies Similac if breastmilk happens to have been supplemented with infant formula. Brief supplementation after birth, if medically necessary, will be ordered by health care providers. If donor milk isn't available infant formula will be used. The infant formula used is usually the formula provided to the hospital through an exclusive contract with a formula maker - in this case the hospital is using Abbott's Similac. Those contracts are a gold mine for infant formula companies as parents typically continue to use the same brand of formula when they leave the hospital.

Abbott Nutrition, the maker of Similac, is undermining breastfeeding by using this bassinet card to convince parents that their health care provider knows best and they shouldn't try to change the feeding "orders."  The words on the back of the card:

"Deciding what to feed is an important decision, one that should be made by those who know your baby's nutritional needs best. Don't make any changes in the feeding that has been specified for your baby without talking with your baby's doctor, nurse or nutritionist. Provided as a keepsake from Abbott Nutrition, Makers of Similac." 

Some parents may interpret this to mean the health care provider, who ordered what was intended to be supplemental infant formula for a brief period, believes that infant formula is better than breastfeeding for their baby. Note the card suggests advice from a nutritionist?

This is what is on the back of a bassinet card
Edmonton mother Rebecca Cameron received from the
Royal Alexandra Hospital. A similar card is shown
in the Alberta Breastfeeding Committee/IBFAN brochure on
WHO Code violations in Alberta.

And who employs a team of nutritionists available night and day to help moms making infant feeding decisions? Why, Similac! Last year over on my other blog, Jodine's World, I wrote about how ads for Similac's 24/7 advice hotline showed up alongside Babble's breastfeeding advice for new moms.

And it's not just Similac's maker Abbott Nutrition using this aggressive marketing tactic. Mead Johnson, makers of Enfamil, also offers nutritional advice and a 1-800 line on their bassinet name tags - every baby born in a hospital with an Enfamil contract in Canada gets this keepsake card to take home with them. On the back:

"Infant Nutrition Questions? Our trusted team is here to help. Call our experts at 1-800-361-6323 weekdays 9AM to 6PM ET or visit enfamil.ca anytime."

Nothing like getting breastfeeding support from the people who have a vested interest in seeing your breastfeeding relationship fail!

After I wrote my blog post about Similac's 24/7 hotline, I heard from a mom who had phoned for advice (Babble.com's Similac hotline a big fat #fail.) She reported an immediate offer to ship free infant formula by overnight courier when she expressed concern her baby wasn't getting enough breastmilk (the number one concern of breastfeeding moms - and the solution is not to breastfeed less!) This mom was also told that after six months a quality infant formula would offer the same benefits as breastmilk.

These bassinet cards are a violation of the International Code of Marketing of Breast-milk Substitutes, commonly referred to as the WHO Code. Hospitals who are accredited under the Baby Friendly Initiative adhere to the WHO Code and do not allow this sort of aggressive marketing tactic.

Here in Canada the Canadian Pediatric Society and Health Canada have called for hospitals to become accredited through the Baby Friendly Initiative. In the US a growing number of hospitals are turning to the Baby Friendly designation as both the CDC and the US Surgeon General renew their push for implementation of these practices.

The US Centre for Disease Control actually has breastfeeding friendly bassinet card PDFs you can download (girl / boy). I've often thought community breastfeeding coalitions and organizations could produce their own cards with local support and help information - but of course that requires money and it seems only the infant formula companies have a marketing budget big enough to cover this cost  - hence the need for an International Code to govern their marketing practices!

Thanks to the many moms who shared their baby keepsake cards with me, thanks to Unlatched for sharing this image on Facebook and provoking me to blog on this issue, and to A Mother Is Born author Meredith Fein Lichtenberg for giving me permission to use it.

Over 6,000 ounces of donor milk distributed to Alberta babies so far this year

Calgary Mothers' Milk Bank director Jannette Festival
with Alberta Breastfeeding Committee conference
delegate Stephanie Harries

At the Alberta Breastfeeding Committee's (ABC) annual conference, held this year in both of Alberta's major cities, Calgary Mothers' Milk Bank director Jannette Festival provided an update on the status of donor human milk in the province.

When the Calgary Mothers' Milk Bank opened its doors this spring Festival forecast between 80 and 100 donors would provide milk in its first year of operation. The milk bank is on track to exceed that forecast with over half of 160 applicants already approved and dozens more on track for approval. The milk bank moved quickly after setting up operations - they pasteurized their first batch of milk on April 3, 2012 and made their first delivery to the Foothills Hospital on April 13, 2012. The average donation is 400 ounces and the bank had already logged 10,000 ounces by June, 2012. They are on track to process 22,000 ounces this year.

This interactive map shows the locations of the
milk bank, hospitals providing pasteurized
human donor milk, and collection depots in Alberta.

ABC Conference attendees in Edmonton were excited by the news that the Grey Nuns began officially using donor human milk on September 5th 2012, with the Royal Alex coming on board at the end of September, ending a brief period of bureaucratic delay that saw milk available in Edmonton only if families paid the milk bank processing fees directly.

Calgary hospitals have already used 3,600 ounces and Edmonton is close behind with 3,100 ounces. Another 2,000 ounces has been provided to Toronto, which is set to open its own donor milk bank later this fall. There is a small percentage of milk that shows a high bacterial count after processing and  it is not suitable to be used as donor milk in the NICU - that milk is used by researchers.

Donors come from across Alberta, and even as far away as Ontario. The milk bank is always looking for donors and is currently a little short of milk - there is a lag between when they first apply and when they make their first deposit.

A collection depot is set to open in Edmonton early October at the Grey Nuns. This will cut the time and expense of moving each individual Edmonton donor mom's milk down to Calgary. The Breastfeeding Action Committee of Edmonton raised funds for the depot earlier this summer.

Also overheard at the conference - exciting talk of moving to fill the need for collection depots in Grande Prairie, Red Deer, and Lethbridge.

Dr. Karleen Gribble: Biomedical Ethics and Peer-to-Peer Milksharing

Biomedical Ethics and Peer-to-Peer Milksharing

Human Milk News is honoured to host this guest post by Dr. Karleen Gribble, adjunct research fellow in the School of Nursing and Midwifery at the University of Western Sydney. This post is an adaptation of a PowerPoint Presentation outlining Dr. Gribble's application of six ethical principles to health worker / patient interactions in the area of peer-to-peer milksharing. 

Photo: Bart Everson

Health authorities in Canada, the US and France have publicly warned parents not to feed their babies peer-shared milk. Many health workers are unsure about how to respond to mothers who are considering being involved in peer-to-peer sharing of milk. Applying the principles of biomedical ethics to the problem may assist in guiding action.

Biomedical ethics can be used to explore actual or anticipated dilemmas in medicine and find reasoned, consistent, and defensible solutions to moral problems.

Principle 1: Autonomy- individuals should be supported to make health care decisions free from deceit, duress, constraint and coercion.

Health Workers are obliged to provide individuals with the information they need to make informed decisions. Limiting of information for the “good of the patient” is paternalistic and interferes with autonomy. Information should only be withheld in very limited circumstances: if the health worker believes that the sharing of information might seriously harm the physical or mental health of the individual or if the individual states that they do not want the information.


Principle 2: Veracity- patients and health workers must be honest with each other.

When parents seek information about alternatives to a mother’s own milk, health workers must discuss all alternatives including infant formula, banked donor milk, peer-to-peer shared milk and wet nursing in an unbiased and non-judgmental way.

Parents must discuss consideration or actual involvement in milk sharing with their health workers.

Policies that prohibit discussing the option of peer-shared milk with mothers could be considered as breaching the ethical principles of autonomy and veracity. They are also dangerous.


Principle 3: Beneficence- minimization of harm and risk and promotion of good outcomes.

The interpretation of “good outcome” depends upon the specifics of a situation and the beliefs and values of the individual. Individuals seeking health care are those who define “good outcome.”

In peer-to-peer milk sharing, beneficence might involve health workers providing information or directing the patient toward information on the correct way of storing and dispensing expressed breast milk or on flash heating or on medications and milk. It might also involve facilitating the sharing of medical records between milk donor and recipient.


Principle 4: Nonmaleficence- active avoidance of harm to the patient.

A health worker who dismisses, mocks, berates or derides an individual seeking advice or information about milk sharing and so humiliates or belittles them could be considered as having breached the principle of nonmaleficence.

A health professional who withdraws care from a mother or child because they wish to be involved in the peer-sharing of milk and does not ensure that appropriate alternate care is available could be considered as having breached the principles of nonmaleficence and the principle of autonomy.


Principle 5: Confidentiality- health providers must not reveal private information without consent.

While sharing of medical records may assist in reducing the risks of peer-sharing of milk, donor records cannot be shared with a potential recipient without the consent of the donor.


Principle 6: Justice- individuals must be treated fairly.

Aspects of justice to consider in the distribution of resources include: distribution equally, or according to need, effort, contribution, merit or notwithstanding ability to pay.

The application of Justice to milk sharing has proven contentious in North America where donor milk banks are experiencing shortages of milk.

Milk banks distribute according to need but payment is required.

Peer-to-peer donors distribute for free and to those who do not qualify for banked milk.

Both groups are applying justice but neither application is unproblematic. Such conflict is not uncommon in biomedical ethics and indicates that further discussion between the players involved is necessary.

Health workers cannot ignore, dismiss, discount or demonize peer-sharing without acting unethically. What then should they do?

• Educate themselves about the various options for infant feeding including the benefits, risks and costs of each option and the ways in which the risks and costs might be managed, reduced or eliminated 

• Be open and honest with mothers about each option and refrain from using pejorative terminology in relation to any option 

• When speaking to the media ensure that information is provided in such a way that it cannot be used to portray breastmilk as inherently dirty and dangerous and that the risks associated with other alternatives to mothers' own milk are considered.

Dr. Karleen Gribble is an adjunct research fellow in the School of Nursing and Midwifery at the University of Western Sydney. Dr. Gribble's research interests include adoptive breastfeeding, long-term breastfeeding, the impact of culture on breastfeeding, non-nutritional aspects of breastfeeding and models of care for newly adopted post-institutionalised children. Karleen speaks and publishes widely on these subjects to lay and professional audiences. Karleen is also active in advocacy and teaching in the areas of infant feeding in emergencies and the marketing of infant formula. In 2011 Human MIlk News profiled Dr. Gribble's research on infant feeding in emergencies in the developed world in #FirstWorldProblems, Are We Doing Enough to Protect Infants in Emergencies? Dr. Gribble has co-authored several papers on milksharing:

Biomedical Ethics and Peer to Peer Milk Sharing - Karleen D. Gribble, BRurSc, Ph.D., Clinical Lactation 20212

Milk sharing and formula feeding: Infant feeding risks in comparative 

perspective?  

Karleen D. Gribble, Bernice L. Hausman,  Australasian Medical Journal, 2012

Milk sharing: from private practice to public pursuit James E Akre, Karleen D Gribble and Maureen Minchin International Breastfeeding Journal, 2011

The World Milksharing Week 2012 Blog Carnival is hosted by Milk Junkies blogger Trevor MacDonald.

Participants:

Milk-Sharing: Safe Infant Feeding and Being a Human - Sustainable Mothering - Jake Markus 

The Lorax and Other Milksharing stories - MatriciativismoenelsigloXXI Jesusa Ricoy-Olariaga

Winning the milk lottery - PhD in Parenting,  Diana West, BA, IBCLC

Scared Milk-less - Peaceful Parenting - Lisa Van den Hoven

Overcoming Difference Through Milksharing - Milk Junkies, Trevor MacDonald

Biomedical Ethics and Peer-to-Peer Milksharing - Human Milk News, Karleen Gribble 

A Story of Peace and Healing - Normal, like breathing, Diana Cassar-Uhl

Milksharing and La Leche League - Feed the Baby LLC, Laura Spitzfaden

Supporting Families in Milksharing as an International Board Certified Lactation Consultant -  Nourish Breastfeeding Support, Amber Rhotan McCann 

"I wish I'd Known About Milksharing When..." - Complete Wellness Concept, Dinnae Galloway

Waiting for Milk Banks: A Matter of Life or Death - Human Milk News, Jodine Chase 

Powerful Images: Supplementing with Donor Milk - DoubleThink, Paa.la, Paala Anderson Secor

What is World Milksharing Week - Dinnae Galloway

 

Roby's Story - mom regains supply and goes on to donate

Human Milk News is featuring a milksharing story every day leading up to

World Milksharing Week 2012 (Sept. 24-30)

This story (which is posted in Spanish but you can use Chrome's translate feature to read it in English) is about a mom who used an at breast supplementer when her milk supply wasn't sufficient. She received donor milk and at the age of five months her child started to refuse the supplementer but still wanted to breastfeed. She discovered she was able to meet all his needs at the breast. Then, as time went on she discovered she has a surplus and was able to donate to another family!

Roby at his mother's breast, donor milk via an at breast supplementer.

Roby's StorySeptember 5, 2012 | Filed under: Stories and tagged with: WMW 2102My story begins with shared milk natural birth of my son, Roby. I suspected that perhaps would not have enough milk for him (never produced enough milk for my first baby), but I had a natural birth to increase chances of success in breastfeeding.He grabbed the breast immediately after birth, and was nursed when wanted from that time forward.... more