CNN Parenting

The 'breast is best' policy backlash

Story highlights

  • One in five women have insufficient milk production in the early days of motherhood
  • Complications from exclusive breastfeeding are common and devastating

(CNN)This story is not an argument against breastfeeding. My party line, after reading a lot of the research and speaking to a number of experts, is that breastfeeding is truly wonderful if you can make it happen but not of significant consequence if you can't. For those who have access to clean water, formula can be a healthy choice.

This is also not an argument against supporting women in their breastfeeding efforts. New moms anticipating a seamless, euphoric process are often surprised to discover that feeding newborns is hard and rarely goes as planned. Breastfeeding requires education and damage control, and the sooner this is offered to pregnant women and new moms, the better the chance they have of successfully breastfeeding -- if that's what they choose to do.
What this story is, then, is a look at whether our current methods of providing support are working for families.
    Over the past couple of years, a growing number of doctors and nurses have begun to question the current strategy. They're worried that the near single-minded focus on breastfeeding often causes hospital staff to overlook risky behavior, unintentionally putting babies and mothers in harm's way.

    'Fed' is best

    Dr. Christie del Castillo-Hegyi gave birth to her son in 2010 at the same Albuquerque, New Mexico, hospital where she worked as an emergency room doctor. The delivery was fairly textbook, and when del Castillo-Hegyi left the hospital a few days later, she had little cause for concern. Her baby was latching well, and so she followed the lactation consultant's recommendation to keep him on the breast with the hope of encouraging her milk to come in.
    The next day she returned to the pediatrician, concerned that her son's fussiness was a response to starvation. Despite his significant weight loss, she was sent home and told to keep him on the breast. Eager to make breastfeeding work, she obeyed orders.
    A day later, her son seemed to mellow out, and she presumed he was doing better. Instead, he had extreme dehydration and starvation, something they would discover at the emergency room a few hours later when her listless son became nonresponsive. He was given formula and stabilized, but it was still too late. Four days without food had caused brain damage, leading to cognitive disabilities that will affect him for the rest of his life.
    Del Castillo-Hegyi has her regrets. In hindsight, she can view the events as an emergency room doctor and wonder why she didn't insist that her child be monitored with the same level of care she would have given her patients. But at the time, she was a new mom, tired and scared, and so she took the lactation consultant's word for it.
    "The whole idea of 'the baby looks fine' is very dangerous. [Failing to monitor glucose levels] can kill a child or alter the rest of their life," she said. "Complications from exclusive breastfeeding are so common and so devastating, I can't understand why [glucose levels] aren't universally checked" when there is reason to suspect that a child might be starving.
    In 2016, del Castillo-Hegyi paired up with Jody Segrave-Daly, a newborn nursery and newborn intensive care unit nurse and certified lactation consultant, to form Fed is Best. The nonprofit is aimed at helping fill in the gap in breastfeeding education by teaching parents the signs of hypoglycemia, jaundice and dehydration and encouraging them to supplement with formula whenever necessary.
    Although there are no studies documenting the rate at which newborn starvation and dehydration happens, there are more than enough anecdotes demonstrating the need for parents to be educated about the symptoms.
    One American study found that roughly one in five women had insufficient milk supply three days after childbirth, leaving a considerable number of babies at risk for these conditions. On its website, Fed is Best points to studies showing that 10% of vaginally delivered and 25% of cesarean-delivered, exclusively breastfed babies lose a potentially dangerous amount of weight in the first days of life, 10% to 18% of babies experience starvation jaundice from insufficient milk intake, and 10% of exclusively breastfed babies experience hypoglycemia.
    In addition to public education, Fed is Best is trying to prevent starvation-related complications through advocacy. These efforts are often met with resistance. In September, del Castillo-Hegyi and her team had a meeting with the World Health Organization to address some concerns about the way the current practices of breastfeeding promotion can inadvertently lead to starvation and dehydration.