Booby Traps Series: When a gift from your OB is not a gift at all

This is the fourth in a series of posts on Booby Traps™ during pregnancy, made possible by the generous support of Motherlove Herbal Company.

Did you receive a formula gift bag at your obstetrician or midwife’s office?  That’s the topic of today’s post in this series on Booby Traps™ we may encounter during pregnancy.

There are at least eight studies showing that formula gift bags given at hospitals decrease breastfeeding rates (even when the formula itself is removed), and I’ll discuss those in a future post.  But until recently there was no research to answer the question: do formula gift bags given at the OB/midwife’s office undermine breastfeeding?

The answer is yes, and the proof comes from a randomized, controlled trial (the gold standard for research) from the University of Rochester School of Medicine.  This study randomly assigned over 500 mothers to either receive a formula gift bag which contained educational information, a formula sample, and coupons for more formula, or a bag with similar materials but with all formula advertising removed.  These bags were distributed at the mothers’ first prenatal visits.  The study found that, while the breastfeeding initiation and long term duration were not affected,

Exposure to formula promotion materials increased significantly breast-feeding cessation in the first 2 weeks. Additionally, among women with uncertain goals or breast-feeding goals of 12 weeks or less, exclusive, full, and overall breast-feeding duration were shortened.

How significant was the effect of the formula bags on the women who stopped before 2 weeks?  The authors say, “Relative risks for cessation before hospital discharge were approximately five-fold higher.”  This amounted to one in every 17 women exposed to the formula bags stopping breastfeeding before she left the hospital.  And those women who had uncertain goals or who intended to breastfeed for 12 weeks or less – the ones who breastfed less and less exclusively if they received the formula bags?  They accounted for over 40% of the randomly chosen women in the study.  The study found that 21% of the women who received the formula bags redeemed a coupon they received for a free case of formula – an outcome which almost certainly influenced their breastfeeding duration.  I think it’s also fascinating that such a strong effect was seen in this population of “largely white, married, middle-class, well-educated women,” a demographic group very likely to initiate breastfeeding, according to CDC data.

And remember, this was all a result of a gift bag given at the first prenatal visit.  Marsha Walker, of the National Alliance for Breastfeeding Advocacy, says that formula companies often have gifts designed to be given each trimester, so that a mom might receive up to 3 or 4 gifts during her pregnancy from her OB.  And Marsha confirmed that as hospitals have been curtailing their distribution of formula gift bags, the companies have been concentrating their efforts on physicians’ offices.

Not surprisingly, the authors conclude, “Formula promotion products should be eliminated from prenatal settings.”

So, what can you do if you’re given formula company material when you go to see your OB or midwife?

Ban the Bags (an organization dedicated to eliminating formula gift bags from hospital maternity wards) has a sample letter you can send to your hospital if you receive a formula bag there, and I’ve modified the letter to apply to your OB/midwife’s practice:

Practice Manager
Obstetrician/Midwifery Practice

Dear Practice Manager,

I recently had a prenatal visit at your office, and am writing this letter to express my concern about the infant formula bag I received from your practice. Even though I am planning to breastfeed, I was given a gift which included infant formula and related promotional materials.

Did you know that research has shown that women who receive formula gift bags in their obstetrician’s office are five times more likely to stop breastfeeding before they even leave the hospital (1)?  Because breastfeeding  is associated with lowered risk of numerous health risks for babies and also for mothers, including lowered risk of breast cancer, diabetes, and ovarian cancer (2), the Centers for Disease Control, the U.S. Surgeon General, the World Health Organization and many other health organizations oppose the distribution of free formula samples and promotional materials.

I have to question whether your practice is truly supportive of breastfeeding when you distribute materials proven to undermine breastfeeding.

I trust you will take into consideration my negative experience, and adjust your practice’s policy regarding free infant formula bags. Please acknowledge my letter and let me know what your plans are for stopping this practice.

Thank you for your time.

Sincerely,

1 Office Prenatal Formula Advertising and its Effects on Breast-Feeding Patterns, Obstetrics & Gynecology: February 2000 – Volume 95 – Issue 2 – p 296-303

2  Breastfeeding and Maternal and Infant Health Outcomes in Developed Countries, Structured Abstract. May 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/tp/brfouttp.htm

You can find Ban the Bags’ entire toolkit here.

So, did you receive a formula bag at your OB or midwife’s office?  Would you ever send a letter like the one above to complain?



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23 Responses to Booby Traps Series: When a gift from your OB is not a gift at all

  1. The community that I work within doesn’t give out formula per se…however Similac has wiggled their way into the hearts of OB’s anyways. I’ve seen mums given Similac supplement drinks ‘for mom’ directly from some of the OB’s that I work with. So, indirectly it is still marketing formula to mums with their brand.

  2. Zaiden's Mum says:

    I just donated the formula they gave me, but I really liked the bag, it was a small backpack, which became useful to keep in the car with a change of clothes and a wet bag!

    I think a mother should KNOW to breastfeed and not give into formula feeding! It’s RARELY impossible.

    The formula gift bag I received had a tag reading: “For Breastfeeding Mothers”… which DID confuse me, as it DID contain formula… But I wouldn’t be angry with an Obstetricians office for giving a gift…

  3. Nicole Cox says:

    No, I would never send a letter like the one above to complain. Although breastfeeding is a wonderful thing for both mother and child I believe there is too much pressure on women to breastfeed. I have two children whom I have breastfeed for a short duration. It isn’t easy…in fact, I found it a very difficult process. I was thankful for the bag of formula with coupons because it made me feel as though there were options to breastfeeding and that I shouldn’t have to feel like a failure as a mother just because something didn’t come easy to me. This is just my personal experience.

    • steph says:

      I think that is exactly the point why the bags are detrimental. Its not just you … Breastfeeding is hard work and usually doesn’t come easy. Formula feeding is easy. So when you are given all the incentives to formula feed you are much more likely to give up.
      Women need help to persevere not goodies that undermine their efforts.yes formula is an option when there is no other choice, personally I don’t settle for mediocre options for myself or my kids regardless of how difficult it might be.

      • valerie asebedo says:

        Breastfeeding takes a commitment to the cause, you have no life at the beginning. It is all about breastfeeding the baby. But because of that, mother’s turn to formula. I was one of four recent mothers in the family, one is the same age as my son, one is a month younger, and the other is two months younger. I am the only one still 100% breastfeeding my 6 month old. Their excuse, back to work, no alone time, can’t drink alcohol. does anyone pay attention to the word ” f o r m u l a “, the formula companies even try to tell you breastfeeding is best.

  4. erica says:

    i wouldnt ban them i would take out the formula n jus take the bag like i have done so… i love the bags im for breastfeeding.. 3 months now n going strong

  5. Naomi says:

    With my first I did receive a bag like this…I wish I had sent a letter in because it may have helped the next new mom. With my second, I had a midwife and got a bag with a bottle but no formula. I have received formula in the mail and sent it back. I have also spoken to each of my OB’s or midwives about how much support is appreciated and I love to see signs about nursing or information on LC’s being posted in their offices. I had one OB say they didn’t feel it was their job to give information about breastfeeding even though it does effect our bodies as well. I wish there was more support. I don’t think taking away “free” formula adds pressure to moms, it just give bran recognition and loyalty and is solely marketing.

  6. Cat says:

    I received *multiple* formula gift bags from my OB’s office, the first one at around 10 weeks’ gestation. (??) This despite a) my having indicated that I nursed my older child and planned to nurse the then-gestating one; and b) my OB stating verbally that “we do encourage” breastfeeding. Huh. Let’s see. You give out five separate gift bags of formula and ZERO gift bags or anything with information related to breastfeeding. How does that “encourage” breastfeeding?

    In retrospect, I wish I had written a similar letter, because had I not been already predisposed to nurse my child and had a lot of support and good information in place, I might have concluded that the “normal” expected thing to do is give formula and that breastfeeding was strange or hard to do.

    I did use the bags that did not feature a huge Similac or other logo after donating the formula.

    I totally agree and understand that sometimes using formula is necessary and it should be easily available to new parents. However, that should be coupled with support for nursing that is easy to obtain and not punitive or stressful. The “lactation consultants” at my hospital should be recruited by the military as drill sergeants. Thank God I wasn’t relying on them either.

    • Tanya says:

      I think that’s just it, Cat. Being handed formula multiple times from your doctor’s office just *has* to create the impression that this is what they expect you to use, whether or not they talk about breastfeeding (and many don’t). And as Bettina says, these are the people we look to for advice about our health, so it carries extra weight.

  7. Dorothy says:

    Wow, I’m suprised to see the support of the ‘gifts’ here in the comments. I was a little insulted and felt like my choice was being undermined when I recieved the bags prenataly and when leaving from the hospital.

    I don’t think a breastfeeding gift/promo bag should have formula in it, period.

  8. Erica H says:

    I think there’s too much pressure on women NOT to breastfeed. Just as this article states, from the moment of conception it seems as if the formula companies are chasing you down the street for your business. I know from personal experience that I received 2-3 more solicitations from formula companies because I listed “breastfeeding exclusivly” on survey’s versus friends who listed they would be supplimenting with formula.
    Breastfeeding can be challenging for some women but women are also told how difficult it is so they have no confidence. Breastfeeding mom’s are called “crazy” or extreme if they choose to nurse exclusivly. Some of the things I heard: You don’t have to be supermom! Just give in. What’s wrong with a bottle? What a hassle to nurse! Aren’t you depriving your husband? Gosh your baby is never going to sleep (he slept 6 hours at 5 weeks). and on and on.
    Breastfeeding is a choice and like all choices mothers need to understand the health consequences of giving their babies formula. They are real.
    If nursing is important to you, learn how to (like you would have to for anything important to you) and stop giving in to excuses.

  9. I can see how these bags can cause confusion…But I think that if a mummie is not convinced to exclusively breastfeed…. it does not matter if she has a free can of formula or not. She can just as easily send a family member to the store to buy a can of formula. I think it depends on how strongly one feels about breastfeeding.

    Formula should also not be looked at as the All Evil Form of Feeding. I see no problem with having a can or two just incase. We got 2 to 3 bags from the hospital per baby. YES I SAID 2 TO 3 BAGS! Each bag had formula and the nurses even gave us extra bottles of liquid formula. They knew I planned on bfing and did not push the bags on us. We asked for more. We liked the idea that if anything were to happen… we had a back up plan. Now with that said…… with my youngest daughter (15 months and still bfing) we just threw out 6 cans of formula and two cases of liquid formula because they were all expired. Did we use them? No…… but we had them just incase. I also have to agree with a previous mummies that the bags and the ice packs have come in handy! I still use all of the ice packs for picnics and to keep drinks cold.

    • Bettina says:

      What bothers me most about the formula samples is that they imply endorsement from the doctor or hospital. And THAT, in turn, can make a mom feel that breastfeeding is not that important.

  10. Aeonix says:

    I recently received something from a major formula company in my email, I don’t know how since I have never signed up for anything like that. I am pregnant with my third and nursed both my babies, this one will be exclusively breastfed too.

    I was rather frustrated to see that even the gifts they were offering those who breastfeed STILL contained samples and coupons for their formula! Way to tell the moms on the fence they won’t succeed.

    I was at my OB’s office a few weeks ago and as I was walking out I saw another expectant mom coming out of one of the exam rooms with a breastpump and breast-feeding goodies. They were definitely promo items but I don’t know if this is a regular thing or if she won some sort of contest the office was having (I don’t know if doctors even do that kind of thing). Maybe with the abysmal rate of breastfeeding in the US they feel it’s worth it. Guess I will find out when I am further along.

    • Rosanne says:

      Maybe the mom just can’t breastfeed… please don’t feel like your doctor is the one in charge of that mother. I couldn’t bf like I wanted because of my PCOS… and I got a lot of people judging me for it, including sister-in-laws. Just live and let live…

  11. suz says:

    On the contrary, my pediatrician in Raleigh, NC has a lactation consultant on-site part-time. Even when I mentioned to the doctor that breastfeeding was going ok at 2 weeks, the doctor asked if I wanted to visit with the LC. She was wonderful and was a great resource 2 months later when a problem arose. Extra bonus, I never got an extra charge for seeing her on our bill.

  12. Tonya says:

    I think this is nonsense!!!!! I’m a mom of 5 children ages 7,6,3,2 and 1. I have nursed all of them and am currently nursing the baby. While I haven’t always nursed a full year or the a 6 months. I nursed as long as was possible for my baby and my family. Breastfeeding is a learning curve and despite popular opinion. Your baby will not starve within those first few days if it doesn’t nurse well. They are created to be that way. They are born into this world having to be taught how to feed. Nursing just takes a while for both Mom and Baby. If more ppl would support the nursing mother instead of shaming them for “showing their breast” or feeling bad about having to be the one doing the feeding, we would have way more woman nursing. yes, another person can’t “feed” the baby but hey, theres diaper changes, bath’s and cuddling to the poor mom can get some sleep. this is just another foolish study done to waste money!

  13. Tonya says:

    oh and I don’t mean to say I haven’t used formula because all 5 of my children have been fed formula out of neccessity when away from me (Mom’s need a break too) but to say they are discouraged from nursing because of being given formula samples is just crazy. I mean you go in the store and go through the baby aisle and what do you see? FORMULA!!

  14. Melissa Cline says:

    I received a formula gift bag when I interviewed my pediatrician. I finally left the practice when he chastised me for breastfeeding and urged me to wean at the nine month visit. I should have left sooner. I got miserably inaccurate breastfeeding information the entire time I was with that practice.

  15. Hannah VW says:

    I agree with this article. These bags aren’t “gifts”, they are advertising. Advertising that works. If your physician really wanted to give you a gift, why isn’t he or she tracking down a free boppy pillow and coupons for free healthy snacks while you’re nursing or recovering from childbirth, or coupons for 1/2 off a breastpump for moms that might need one. Or including a free lactation consultant visit in your birth and prenatal fees.

    Formula has it’s place when breastmilk (mom’s or donated) isn’t available, but I don’t think a doctor should be handing out coupons for it. Why would they want to do that if they know it decreases breastfeeding rates? Coupons are available from the companies or online if someone needs or wants them.

  16. Jen says:

    I don’t agree at all with banning the bag…I get more formula from the mail then I have from my OB or hospitals.

    If you want to stop this trend of women giving in to the sample formula too soon, REQUIRE HOSPITALS to have lactation consultants meet with all moms and talk about the struggles of BF.

    If a mom is struggling and doesn’t know its ok for her milk not to come in for 5 days and she is ready to grab for the sample…guess what, she is also ready enough to send her hubby or even go herself to the local 24 hour store and pick some up. Stopping these bags is not going to change anything, EDUCATING MOMS WILL!!!

    • Bettina Forbes, CLC says:

      You are correct that all hospitals SHOULD have lactation consultants, however, studies do show that stopping the formula bag giveaways by healthcare providers increases breastfeeding initiation and duration.

  17. Rosanne says:

    Just as a side note, I appreciate the bags and free samples given to me by both my ob and the hospital. I try to breastfeed my babies… I’ve had 3, and despite many nursing coaches, natural remedies, etc… my milk always dries up within a month of the baby’s birth. I was devastated at first, but instead of beating myself up over something I had no control over… I fed my hungry babies the free samples that were given to me by the doctors. I really appreciated it since formula for my babies is anywhere from $100-$200 a month. I don’t mind a week or two of free formula.

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