If you're pregnant, you've probably already thought about how you'll inevitably feed your baby. It's natural to wonder how the hospital you deliver at might play a roll in that decision, too. If you plan to formula-feed from the start, or simply want to have formula available in case breastfeeding doesn't work out or you want to supplement, you might be surprised to learn that there are actually "rules" about hospitals offering formula. At some hospitals, getting formula to feed your baby isn't as easy as asking for it or checking a box on an intake form.
According to Baby-Friendly USA, U.S. hospitals that have received a Baby-Friendly Hospital Initiative (BFHI) designation must follow certain rules about when and how they offer formula to new parents. Designed to promote exclusive breastfeeding, they follow the World Health Organization's (WHO) "Ten Steps to Successful Breastfeeding," which, as SELF reports, might limit a new parent's ability to use formula to feed their babies in these specific hospitals after childbirth. According to the 2016 BFHI guidelines, all babies are to be considered breastfeeding unless, after receiving breastfeeding counseling and education, their moms state otherwise. This means that, at some hospitals, nurses are not allowed to offer formula unless it's requested, or, as reported by the Fed Is Best Foundation, new moms have signed a waiver acknowledging the so-called risks of formula-feeding. Other hospitals will allow formula only with a doctor's prescription.
If you decide to supplement with formula, the BFHI recommends that you not use a bottle, because they believe it might interfere with breastfeeding. Instead, some BFHI hospitals have new moms use a syringe, cup, spoon, supplemental nursing system, or even their finger and some tubing to give their baby formula when needed. So with that in mind, here's a few formula-feeding rules some hospitals abide by that all parents should be aware of:
No Free Formula Samples
According to Baby-Friendly USA, BFHI hospitals are required to follow the World Health Organization's "International Code of Marketing of Breast-Milk Substitutes," which means that they can't give out free samples of formula or related supplies, like bottles or nipples to new parents.
They Can't Offer Formula
In order to promote exclusive breastfeeding, BFHI hospitals are not allowed to offer formula unless it is requested. According to their 2016 Guidelines and Evaluation Criteria, "Breast milk should be the standard for infant feeding. All infants in the facility should be considered to be breastfeeding infants unless, after giving birth and being offered help to breastfeed, the mother has specifically stated that she has no plans to breastfeed."
Only If Medically Necessary
According to Baby-Friendly USA, hospitals are allowed to offer formula if it is medically necessary. In practice, however, the process can be a bit more complex. As mom Julisa Gendren told Romper via email, "I had to sign my name eight times to give my daughter formula. I asked for a lactation consultant, but there weren't any available because it was the weekend. It was the middle of the night. I had been nursing for two hours straight, and [my daughter] was inconsolable. She had lost seven percent of her body weight on day two of her life."
Only If Mom Signs A Waiver
According to the Fed is Best Foundation, some hospitals require moms who want to use formula to sign a waiver, acknowledging the "risks" of formula feeding, which they claim are not based on facts or scientific evidence. Romper corresponded with one new mom, K, via email who went through this process at a BFHI hospital in Bakersfield, California when her second child was born eight weeks ago.
"It was the night I had given birth. I had been breastfeeding for hours on and off," she says. "I knew [my son] needed some formula, and I needed a break. I hadn’t slept in days. I called the nurse, asked for formula, and when she came back with it she said, 'I have to have you sign this before I can give you this formula.' I was exhausted and alone and completely unable and unwilling to argue even though I felt it was unfair."
Only With A Prescription
As mom of two, Victoria Lopez-Garrett learned that some hospitals even require a prescription for formula. She told Romper via email, "I had to bring a prescription for formula, since I wanted to formula-feed from birth with my second. With my first I was denied formula because I didn’t have a prescription. The next day at her pediatrician's office, we found out she had lost over a pound. She was starving. I had been instructed to starve her."
You Can't Use A Bottle
When she had her son two years ago, first-time mom Whitney was shocked to learn that bottles weren't allowed at her hospital. She told Romper via email, "Formula was never offered, not even after my son was readmitted with dangerous bilirubin levels. As a first time mom I was too nervous to ask for it, and the lactation consultant told me it wasn’t necessary and that I just needed to nurse, pump, and then finger feed every two hours, because bottles weren't allowed."
According to the BFHI Guidelines, "any fluid supplementation (whether medically indicated or following informed decision of the mother) should be given by tube, syringe, spoon, or cup in preference to an artificial nipple or bottle."