The Rise of the “Fed Is Best” Campaign

When it came to breastfeeding, Ashlee Todd’s son Lincoln was born ready. Within hours of his cesarean birth at a local hospital last December, the healthy 7-pound-5-ounce newborn earned praise from nurses for his perfect latch. But after 36 hours of near-constant nursing, Todd’s milk hadn’t come in and Lincoln seemed restless and fussy. She asked for formula to feed him, but her requests were brushed off, she says. 

“At one point, a nurse told me I’d have to pump for 10 minutes before she’d give us any formula. It was like she was holding his food hostage.” By Lincoln’s third day of life, his weight had dropped by over 12 percent, a loss doctors deem “excessive” and one Todd says could have been prevented. “By the time we left the hospital, he was lethargic. He had essentially had no food during those first days,” she says. 

Helping new mothers like Todd nourish their newborns is the goal of Fed Is Best, a new advocacy campaign created by a physician and a lactation consultant. Its supporters claim that gaps in education and support leave new parents without the information they need to feed their babies in the first weeks of life. In extreme cases, they say, this misinformation is putting vulnerable infants at risk.

How the campaign started

Launched in 2016 by emergency room physician Christie del Castillo-Hegyi, M.D. and board-certified lactation consultant Jody Segrave-Daly, R.N., Fed Is Best’s mission is to promote safe breastfeeding and bottle-feeding support. They hope to counter a decades-long “Breast Is Best” push for exclusive breastfeeding that del Castillo-Hegyi says harmed her own infant son.

After breastfeeding rates dropped in the 1980s, the World Health Organization (WHO) and UNICEF launched the Baby-Friendly Hospital Initiative (BFHI) in 1991 as part of a global effort to promote breastfeeding.

Today, there are more than 500 Baby-Friendly facilities in the United States (and 20,000 globally) where hospital staff follow the BFHI’s “Ten Steps to Successful Breastfeeding.” The steps support early and frequent nursing by keeping moms and babies together as much as possible. Infant nurseries, pacifiers and formula aren’t provided, except when medically necessary. 

Since the BFHI rolled out, breastfeeding rates have climbed steadily, hitting an all-time high of 82.3 percent for babies born in 2015. Today, the “Breast Is Best” mantra still offers welcome encouragement for new parents who want to breastfeed, says Nancy Patel, a Seattle mom currently nursing her fifth child. “I liked knowing that “Breast Is Best” when I made sacrifices to pump for my daughter in day care.”

“There’s an amazing array of literature supporting exclusive breastfeeding as the gold standard for infant nutrition,” says board-certified lactation consultant Sandy Salmon, R.N., nurse manager at Overlake Medical Center’s Mother Baby Unit. “Exclusive breastfeeding is backed by the WHO, Centers for Disease Control, American Academy of Pediatrics, Academy of Breastfeeding Medicine and the American College of Obstetricians and Gynecologists as the best way to feed babies.”

Because breastfed infants get fewer ear infections, respiratory illnesses and digestive problems like diarrhea, the WHO reports that increasing breastfeeding rates could save 800,000 infant lives each year. Breastfeeding benefits moms, too, providing some protection against breast and ovarian cancers.  

When breast isn’t best

Though most mothers intend to breastfeed their newborns, recent childbirth trends mean more parents like Todd will experience delayed milk production, defined as breastmilk that comes in three or more days after birth. That's due to a rise in cesarean births and late pre-term births — both risk factors for delayed milk production, says board-certified lactation consultant Kelsey Stevens, R.N., lactation program coordinator at Northwest Hospital & Medical Center. Though many of these parents can go on to breastfeed exclusively, some need additional feeding support in the early post-partum period.

“Mothers are led to believe that it’s rare not to produce enough milk for their baby. In fact, it’s not rare,” says Segrave-Daly. Studies show that 22 percent of moms who want to breastfeed experience delayed (by more than three days post-birth) milk production after childbirth; rates jump to 44 percent for first-time mothers.

“Mothers only hear about the benefits of breastfeeding, but never the downsides,” says del Castillo-Hegyi. For example: Compared to infants who get some formula, exclusively breastfed infants lose more weight during their first days of life and they’re more than twice as likely to be readmitted to the hospital after discharge. 

Newborns who don’t get enough to eat risk dehydration, hypoglycemia (low blood sugar) and hyperbilirubinemia (elevated bilirubin levels that cause the yellowing of the eyes and skin known as jaundice), says del Castillo-Hegyi.

Jaundice is common for newborns, but it’s slower to resolve in exclusively breastfed babies. The condition usually doesn’t cause long-term problems. But when babies experience both dehydration and jaundice, a small percentage can develop bilirubin encephalopathy, a disabling condition that accounts for as many as 15 percent of newborn deaths worldwide. 

Because moms often aren’t aware that their hungry babies are in distress, says del Castillo-Hegyi, undernourishment of newborns can risk damage to the brain and other vital organs. Fed Is Best’s parent resources are aimed at helping mothers prevent and respond to a medical emergency, she says.

“In the end, we all have the same goal.”  

Supporting healthy families

Though Baby-Friendly Hospitals commit to support breastfeeding, their intent is never to pressure or shame mothers for their feeding choices, says Salmon. “All babies are monitored closely and given supplements if needed. The health of the mother and the baby always come first.”

“A lot of moms are struggling, and we want them to know it’s okay to give your baby formula,” says Stevens. “In the end, we all have the same goal.”  

Thanks to the support she received from Fed Is Best, Ashlee Todd and 6-month-old Lincoln are both thriving. “Ironically, now I produce plenty of milk, but it took a couple of weeks before I had a full supply.” 

“At the hospital, I felt like they forgot about me, as the mom,” she says. “All I really needed was some compassion.”