Fed Is Best Foundation vs the Baby Friendly Hospital INITIATIVE - A Question Of Ethics Part 1

Last week Forbes released an article entitled “Fed Is Best Foundation Says Says WHO Breastfeeding Guidelines Fail To Meet Human Rights Standards"

Just digest that for a minute because, that’s huge. 

That’s a really massive call.

And if your first encounter with the Fed Is Best Foundation was reading the Forbes article, you would probably come away agreeing that the WHO is being negligent and denying babies human rights. ​

So, you might be wondering if their claim is valid. 

Is the Unicef/WHO focus on breastfeeding rates and the Baby Friendly Hospital Initiative putting babies lives at needless risk for the sake of politics?
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Last week Forbes released an article entitled “Fed Is Best Foundation Says Says WHO Breastfeeding Guidelines Fail To Meet Human Rights Standards"

Just digest that for a minute because, that’s huge.

That’s a really massive call.

And if your first encounter with the Fed Is Best Foundation was reading the Forbes article, you would probably come away agreeing that the WHO is being negligent and denying babies human rights.

Considering that the article contained this paragraph “As I’ve discussed several times, including here, here and here, the world’s leading medical institutions and media hype the breast is best adage, overinterpreting studies that say no such thing. It’s a disservice to mothers and infants. Lactation consultants and leading breastfeeding advocacy organizations say that newborns who nurse frequently will get enough milk, and that a newborn doesn’t need much milk in the first days of life. In reality, up to 15 percent of moms don't produce enough milk due to complex factors including genetics. Insufficient supply in the first days after birth is more common in first-time mothers.” and the suggested reading posts that came up included one entitled “Put down that stranger’s breast milk and pick up a container of formula”, I certainly have my suspicions about the author’s bias.

But it was technically an opinion piece, with the usual disclaimers about opinions shared not being the opinions of Forbes in general, blah blah blah. 

So, you might be wondering if their claim is valid.

Is the Unicef/WHO focus on breastfeeding rates and the Baby Friendly Hospital Initiative putting babies lives at needless risk for the sake of politics?

Well there are a few things we need to unpack here.

First is the history of the Fed is Best Foundation.

Founded in 2016 by Dr Cristie del Castillo-Hegyi the Fed is Best website’s About page states: “The Fed is Best Foundation is a non-profit, volunteer organization of parents and health professionals who study the scientific literature on infant feeding and real-life infant feeding experiences of mothers through clinical practice and social media connections. We seek to provide information on the safest, most brain-protective methods for breastfeeding, mixed-feeding, formula-feeding, pumped-milk-feeding and tube-feeding mothers and families to prevent complications to babies that have become too common in today’s “Breast is Best” world…… The Fed Is Best Foundation is here to represent and advocate for the millions of families whose babies have experienced complications under current breastfeeding protocols or who have been shamed for choosing any number of clinically approved and safe feeding options for their babies.  We hope to educate mothers to be informed about the quantity and quality of milk their infants receive in order to prevent these complications because the brain will not wait for food.  We hope to support mothers feeding choices devoid of external feeding agendas.
Our motto above all else is Fed is Best.”

What no longer seems to be listed is Dr del Castillo-Hegyi’s personal story, and her belief that dehydration is the leading cause of her child’s Autism. “Del Castillo-Hegyi, whose son was diagnosed with autism spectrum disorder, ADHD and other developmental delays at age 3, believes that there is a strong link between such impairments and insufficient newborn feeding”

The Fed Is Best Foundation also lists the following “Advocates and Advisors”

Dr Brian Symon. Adelaide Paediatrician, best known within Australia for the controversy around his appearance at the Pregnancy, Babies and Children’s expo. He was pulled from their 2014 lineup after major parent backlash in regards to his sleep training methods for newborns. Back on the ticket in 2015 despite the concern of many organisations and parents, I was in the audience of his talk where he announced that red-haired women usually can’t breastfeed and that newborn babies should only feed once per night (between 7pm and 7 am). You can read my full coverage of this controversy here

Amy Teuter MD. Is an American ex OB-Gyn who is often interviewed in mainstream media publications for anything relating to birth and parenting, despite the fact that she hasn’t actually practised medicine since 2003. She is the founder of the website Hurt By Home Birth, “in which she invites guest posts—“and please include pictures if you can”—from tragedy-stricken mothers.”
Her breakdowns of scientific research have been known to contain multiple factual and mathematical errors, like the ones outlined in this article, (ironically found on the site of another Fed Is Best Advocate) which isn’t that surprising if you consider that she is both anti-homebirth (claiming it needlessly kills babies, despite being safely practised in many European countries), and  pro-circumcision, a practice which is only performed in the USA and has actually been made illegal in most of Europe.

She also regularly descends on the blogs and facebook pages of birth and breastfeeding advocates, attacking the comments section with such ferocity that a number of websites have flagged her as a spammer. In 2013 she filed a lawsuit against blogger “The Feminist Breeder” and is quoted as saying that  she "uses her blog in part to wage war on proponents of home birth.”

Now it seems extremely strange to me that any organization claiming to be evidence based, would choose to align themselves with people who are well known for dismissing large swaths of research they don’t personally agree with, cherry picking data and funding their own studies to support their claims, and making claims that run counter to the general consensus on a topic in the rest of the world.

It seems even more bizarre and extremely hypocritical that an organisation claiming to promote brain-protective feeding methods in order to stop an “epidemic” of infant dehydration would align themselves with a paediatrician who insists that a newborn baby only needs to be fed one, maybe two times in 12 hours. The WHO and BFHI both actively state that babies who are yet to regain their birth weight must be fed at least every 4 hours or they are at risk of dehydration. But even for babies who have regained their weight, going 12 hours with only one-two feeds puts them at major risk for both dehydration and failure to thrive, as well as seriously undermining mum’s milk supply.

And that’s really the core problem with these particular advocates. Whilst both of them claim to support breastfeeding, the information that they present in their blogs, books, interviews and talks is full of misinformation, and the promotion of practices that are known to inhibit milk production, destroying a mother's chances of breastfeeding success, putting her baby at risk of major health complications, and making mums vulnerable to beliefs that they (the mother) are to blame.

The rest of the list of advocates and advisors contains an impressive mix of qualifications. Nurses, Psychologists, a Statistician and so on, but, almost every bio provided had one of two things in common. Personal experience with a dehydrated baby, or personal experience with the “pressure to breastfeed”.

Now the inclusion of mother’s who’s on babies experienced dehydration and the resulting complications makes sense. It’s not necessarily ethical, you could argue that it is exploiting women’s grief, but it makes logical sense. After all the Foundation’s purported aim is to prevent “complications associated with exclusive breastfeeding” and promote awareness of hypernatremic dehydration, hyperbilirubinemia and hypoglycemia.
The inclusion of advocates who experienced “pressure” to breastfeed, however, is slightly confusing. Sure their about page also includes this sentence “(The Fed Is Best Foundation is here to represent and advocate for the millions of families) or who have been shamed for choosing any number of clinically approved and safe feeding options for their babies” but the context of the full statement makes it sound like they are talking about parents who have chosen to supplement or formula feed specifically to avoid dehydration issues and have been shamed for that.

The bio’s however run more along the lines of “I wanted to breastfeed, but received bad information, which made me feel like a failure, so I turned to formula and the FIB foundation were there to support me when everyone else just ignored my problems.”

That’s very different.

Now when you read through the countless stories on the FIB blog or Facebook page, you will find a common theme. Mother wanted to breastfeed. Encountered difficulties and a major lack of effective support, felt like a failure, turned to formula in desperation, possibly after re-admission to hospital. Decided that the Baby Friendly Hospital Initiative or breastfeeding educators in general were to blame and turned activist against exclusive breastfeeding (or breastfeeding at all).

I’m with them up until the last step.

And honestly, I can understand why they chose that path, they’re hurting and they want to save others from their pain.

Yet Teuter and Symon, advocates for the Fed is Best foundation, are two of the most well known sources of misinformation.

The core problem here isn’t actually with the “breast is best” mantra. The problem is women’s healthcare.

The same issue is seen time and time again across all aspects of women’s health. Birth, breastfeeding, reproductive and hormonal health, mental health - women presenting to health professionals with problems who are ignored, belittled or given terrible advice by people who have very little training in that area but refuse to refer them on to a specialist, or claim to be an expert when they are really pedalling bullshit.

Birth and breastfeeding have two added complications.

1: when something goes wrong and a baby or mother dies/is harmed, it’s extremely emotive for everyone. That not only makes it hard for those directly involved to look at a situation objectively. It also makes it hard for anyone hearing their story to look at it objectively.

This creates fear.

And fear is never an appropriate place from which to assess truth.

I’m not saying these women are lying about their experiences. I absolutely believe them in their claims they were harmed. I also absolutely agree that it was iatrogenic (health provider caused) harm. I do however question the claim that BFHI protocols specifically are the root cause of the problem.

2: The women involved had goals, things that were extremely important to them, that they are then unable to meet because of bad support and inaccurate information. These women are  then gas-lighted; made to feel like it was their own fault for having those goals in the first place.

Baby Friendly Hospitals are not immune to that phenomenon.

The existence of the Fed is Best Foundation does raise a very valid point: that attending a Baby-Friendly hospital or seeing a Lactation consultant is no guarantee of breastfeeding success.

There are definitely issues with the BFHI implementation. Chief among them being a lack of follow up on the quality of breastfeeding help mothers are receiving.

Re-admissions should absolutely be tracked. Patient breastfeeding success rates and continuation rates should be being tracked. Patient satisfaction with the information and help they received should be being tracked.

You can not expect to measure the success or failure of a program if you don’t collect the data.

But you also cannot make a claim that the program is universal problem if you don’t have the data.

If we had the data, then we might find that all baby friendly hospitals in, say, Finland have very low readmission rates, high rates of patient satisfaction and high rates of continued breastfeeding, but US hospitals show the opposite. That would suggest that the issues have more to do with the politics of individual countries than the BFHI as a whole.

Conversely if we had the data we might find that hospital 1 in Newcastle (AU) has great statistics whilst hospital 2 has mediocre statistics and hospital 3 has abysmal statistics. That would then suggest that the outcomes are influenced by implementation, staff rostering, follow up training and outpatient care.

Or if we had that information we might find that baby friendly hospitals perform worse that non-baby friendly hospitals regardless of location.

But without the necessary information, we can’t assess the program as a whole.   

However, given the issues seen in birth  (where no equivalent worldwide scheme exists). Given women’s lived experiences of birth control or psychiatric medications destroying their health. Given that it takes a woman an average of seven years and five doctors to get an accurate diagnosis for things like CFS or thyroid disorders, the problem is clearly far bigger than just the BFHI’s policies.

(side note: In one blog post on the FIB website, a mother shares the lengths that she had to go to in order to first access her hospital records, and then file a complaint. She recounts being brushed off, ignored, or being sent form letters from multiple organisations. Baby Friendly USA were actually the only ones who helped her to navigate the complaints process, nonetheless the tone of the article is one of “see how negligent BFH and the Breastfeeding promotion industry are because no one would listen to my complaints. But here’s the thing, once again this is not limited to just breastfeeding. It took Kimberly Tubin a full year to find a lawyer who would take her case and she had video evidence of being violently harmed by her OB. That year was on top of the previous couple of years she had spent calling and writing to the hospital, attempting to resolve the issue directly with them via meetings, then moving on to the police when the hospital proved they were not interested in dealing with her case. In terms of birth control it took a Facebook group of 20 000 women creating a coordinated complaint and awareness campaign for the FDA to put a black-box warning on Essure. The roadblocks that the author encountered are the same roadblocks that every woman making a complaint against a hospital or healthcare provider encounters.)

Now obviously as the overseeing organisation for thousands of hospitals and birth centers worldwide, the Baby Friendly Initiative have the power to massively influence breastfeeding support/care worldwide. So they are a good organisation to approach.

But is the approach Fed is Best Foundation is taking actually going to help anyone?
Continued in part 2.

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