Whoopi Goldberg and friends on The View just threw a Molotov cocktail of ignorance into the middle of the Mommy Wars.  This time it’s about whether hospitals have the right to market formula to new moms with free samples. The women of The View give a unanimous, “Yes.”  But the proposed ban on marketing is not about women being bullied into breastfeeding.  It’s about standing up for our freedom to make our own feeding choices, freedom from commercial influences in the one place where they certainly don’t belong—the hospital.

Let’s be clear. Formula companies distribute free samples in hospitals for one reason: to sell more formula. Specifically, to sell more high-priced brand-name formula. Abundant market research shows that women stick to the brand of formula they got in the hospital.  Knowing that babies often don’t tolerate formula well, moms wisely stick to a brand that’s worked for them. That’s why the makers of those pricey brands compete, often viciously, to be the brand a hospital uses. These brands will cost a family at least $700 more per year than store-brand formula, which may be every bit as good, since the government regulates what ingredients must be included.

Those free samples to moms come with a hitch. They are not just “free” to the moms. Formula companies want your business so badly that they will vie for the privilege of supplying most of the hospital’s formula for free. Yep, you heard that right. Unlike any other product, the formula company representatives bypass all hospital purchasing policies and quality control, and wheel their cache right up to the maternity ward, in the hopes that nurses will dole it out like confetti.

It’s a brilliant strategy. It helps make the United States the biggest single consumer of infant formula in a $10 billion a year global market. Hospital staff love to be helpful. They went into health care to help people. The formula companies are well aware of this instinct for well-meaning nurses to rain freebies down on moms.

Think you’ll get more sleep if that helpful nurse takes your baby to the nursery? That’s another myth the formula companies prey on. One nurse may be looking after 5 or six babies. It’s no wonder research shows that babies do better next to their moms, and moms get just as much sleep whether their babies are with them or not.

For moms who chose to breastfeed, the abundant supply of free formula is even more problematic than it is for moms who choose formula. Research shows that one of the biggest predictors of breastfeeding failure is giving babies formula in the early days when there is no medical reason for it. (For more information on these issues, check out these sites: http://www.ncbi.nlm.nih.gov/pubmed/18563999, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5723a1.htm)

This interferes greatly with the mom’s ability to establish an early and abundant milk supply, and interferes with the well-choreographed dance between baby’s hunger and mom’s body. As many moms will tell you, one bottle then leads to another, and pretty soon mom’s milk supply dwindles to nothing.

When that happens, moms have to buy formula for the rest of their baby’s first year, just as surely as the diabetic has to buy insulin. Formula companies sell a product with only one market, babies, and there are only so many babies born every year. So the only way to sell more formula is to sell less breastfeeding. It’s as simple as that.

Those free bottles of formula come in handy at home, when a mom is at her wits’ end in the middle of the night. And that’s the whole point of them.  If breastfeeding doesn’t get off to a good start in the hospital, we know that it's much more likely that a mom will go home and struggle.  A bottle of premixed, ready to use formula is awfully tempting, even for those of superhuman willpower. Then that mother-baby dance is interrupted, and for most babies, breastfeeding is likely to go from bad to worse.

Contrary to popular belief, breastfeeding doesn’t tend to go badly because of maternal factors. It tends to go badly because of hospital factors. The Centers for Disease Control and Prevention conducts a biannual survey of how well hospitals conform to evidence-based maternity practices around infant nutrition and care, the mPINC survey. Out of 100 possible points, the average US hospital scored just 65, a solid D. Even average hospital the top scoring states were only in the low 80s.These evidence-based practices, the Ten Steps to Successful Breastfeeding, make a huge difference to long-term breastfeeding rates. What happens in the hospital is crucial for breastfeeding success.

When there’s abundant free formula around, it’s a lot harder for hospitals to change their long-established routines and implement the WHO’s Ten Steps to Successful Breastfeeding, the protocol upon which the mPINC survey is based. So, why are hospitals marketing baby formula instead of implementing the Ten Steps? That’s the question we should all be asking.

We would find it absurd if hospitals’ cardiac units gave out coupons for Big Macs. Commercial marketing doesn’t belong in hospitals. No matter how you feed your babies.

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