Want me to sign a breastfeeding “waiver”? I have a letter for you first

With all the cheering from the breastfeeding sidelines in response to Mayor Bloomberg’s Latch On NYC initiative, I can’t help but relive my newborn days with my own babes.

What would I do when faced with a well meaning nurse, educating me on the countless benefits of breastfeeding and then asking me to sign a “waiver” of sorts when I sheepishly ask for some formula.

Well, here’s what I would want to say, though there’s no way those words would spill forth form my mouth through an incomprehensible flood of tears…

Dear sweet nurse asking me to sign a breastfeeding “waiver” of sorts,

I would give anything to be able to breastfeed my daughter. Anything. I’m not over exaggerating either. I’d give my left boob if my right one would pick up the slack and give my daughter what she desperately needs and what I desperately want to give her.

But I’m broken.

Plain and simple.

I wasn’t blessed with breasts capable of producing sufficient amount of breastmilk to sustain my babies.

It was a heartbreaking discovery after the birth of my first child. I have IGT (Insufficient Glandular Tissue). I don’t know if you’ve heard of it but yes, it’s a real medical condition. As real as the agony, pain, and tears that overcame me each and every time I prepared and fed my son that much needed bottle of formula.

Not every woman can breastfeed. It’s not a myth. Not a sign of lazy parenting. And certainly not an indication of how much every woman loves her babe and just wants to be able to provide them with their most basic need.

I understand you are just doing your job, and for that I thank you.

But please know, I am trying to do mine as well. To feed my newborn child. In peace. With love. And without added guilt.

Yes, I am quite aware of the numerous benefits of breastfeeding and breastmilk. God how I wish I could give my children that. I do what I can. I will put my daughter to my breast, as I did with my son. I will give them what I can. Which isn’t much. Even with around the clock pumping, supplements to boost my milk production, an SNS, and a crazy amount of hoping and praying.

But…in about 24 hours my babe will start crying out for more. Even my colostrum is miniscule and not enough.

So, do what you must. Sign out that baby formula. Or better yet, get us on our way home.

I don’t need a capital “F” on my daughter’s bassinet.

I want to go home. Hold my daughter close to me. Skin to skin. Look in her eyes…and feed her with all the love in my heart.


A heartbroken mama who cannot even look at you or speak lest I crumble in an avalanche of tears.


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34 Responses to Want me to sign a breastfeeding “waiver”? I have a letter for you first
  1. Raymond
    August 1, 2012 | 1:18 pm

    Love it, Dr. Arca! Thank you for sharing your experience.

  2. Nancy
    August 1, 2012 | 1:58 pm

    Thank you again for speaking for those of us who cannot breastfeed. We are a small group. I hope you share your story with your colleagues to ease up a bit on the message.

  3. Melany
    August 1, 2012 | 2:18 pm

    Thank you for your letter. Sometimes we prepare and prepare and things don’t go as we plan – especially in childbirth. Its hard enough when things don’t go our way – but to have others put pressure on a new and delicate relationship just isn’t fair.

  4. Tracey
    August 1, 2012 | 2:28 pm

    I feel like you just spoke from my heart at the way I felt while in hospital with my son….I also could not breast feed due to lack of to NO supply a d was starving my son due to the nurses not allowing me to give my son a bottle….I cried along with my son every feed and all day as he was starving. When I got home and put him on the bottle I continued to cry because I felt like a bad mother that was putting my new born at a disadvantage by giving him formula….thank you for putting this out there and letting others know that for some the inability to breast feed can be emotionally devastating!!!

  5. Cat London
    August 1, 2012 | 2:41 pm

    I could have written this, word for word. I have hypoplasia breasts and my baby needed formula to survive — lots of it. Any future children I hope to have will be in the same boat, no matter what I do. I spent my daughter’s infancy feeling like we both had scarlet Fs on our bodies. I too would have done anything for a full supply, or even a 50% supply, of breastmilk. But I never had that option, and even though that wasn’t my fault, I was made to feel that it was. All parents need support, not judgement, and everybody needs to stop presuming to know what’s best for everyone else’s children. Thank you for posting this.

  6. michele
    August 1, 2012 | 4:08 pm

    Thanks for sharing this. As an adoptive mom, I was fortunate to be able to TRY to breastfeed, with alot of medication and pumping, before we were even sure there would be a baby. Then my son was born with a cleft palate so it made it even harder. Plus, I really wasn’t able to produce that much. I still carry the disappointment that my body failed me on so many levels. I cant’ imagine being in the hospital and being told I was doing less than for my child. This new program is wrong in so many ways. New parents don’t need the government telling them how to care for their children, much less guilting them into it.

  7. Jenny
    August 1, 2012 | 4:35 pm

    Beautifully written!

  8. ddfarrell
    August 1, 2012 | 4:59 pm

    One child at 23. How about if I just didn’t choose to breast-feed? No illness, not “broken”. I didn’t want to do it!
    At 66, I also want to use those big incandescent light bulbs, the ones that provide enough light so I can actually read/see.

  9. Nina
    August 1, 2012 | 4:59 pm

    Thank you! I had the same experience with breastfeeding, and I was also completely heartbroken about it. I didn’t need anyone to tell me I should feel worse. There was no way I could have felt any worse. It’s really just a horrible shame to treat mothers this way.

  10. Jenn
    August 1, 2012 | 6:36 pm

    Thank you for this!! I have Lupus, Sjogren’s Syndrome and Reynaud’s Phenomenon. My daughter was hospitalized at about 5 days old because of dehydration. It was SO HARD to give up on breastfeeding because of the peer pressure!! Not every woman can, or wants, to breastfeed. Please don’t judge, because trust me when I say that we have already judged ourselves harshly. But we’ve mourned the loss of nursing and yet we have bonded with our babies. And the second time around with baby number two? Well, mourning that particular loss was a little easier.

  11. Emily
    August 1, 2012 | 7:20 pm

    Thank you for reaching into my heart and saying it so clearly. I had a horrific time getting started breastfeeding. Daughter had jaundice and I had inverted nipples. I spoke to everybody/anyone on how I could be successful. A La Leche League member told me I should spoon feed my baby BM instead of using the bottle. Lack of sleep made me let that woman leave my house without a roll of the eyes and boot out the door. Luckily I was able to pull me and my bloody nipples through to success (along with the support of my husband); however, when my daughter was 7 months old I was diagnosed with Graves’ Disease and had to immediately wean her to formula (no breast milk stash as she refused the bottle at 3 months). I had to get myself healthy so I could be the best mom (and wife) I could be. Taking radioactive iodine to kill my thyroid was not at ALL how I imagined my breast feeding journey to end. THANK GOODNESS for formula. We all need to recognize that judging and condemning women for formula feeding is not the way a kind mother should act.

  12. Lorette Lavine
    August 1, 2012 | 7:23 pm

    Thank you for writing this….Mayors should stick to politics and running their cities not whether a mom breast or formula feeds her newborn. Mothers should be given a choice and respected for that choice…some one who is fully informed can decide on how they are going to feed their child. It is very sad that we have to put a guilt trip on moms and now it is coming from City Hall as well.

  13. Elizabeth
    August 1, 2012 | 7:37 pm

    I am so sorry you went though that. As a breastfeeding momma I understand that it is not for everyone… If its not right for momma or baby its just not for you… Looks like you and these other moms took good care of your babies no matter what.. A+ Ladies

  14. Melissa
    August 1, 2012 | 9:10 pm

    Yes this is heart breaking but let’s not misunderstand the program being implemented. The ny post is notorious for exaggerating and the article does not fairly characterize the program. First off it is voluntary, hospitals can adopt it or not and any mother can choose a hospital that does not participate in the program.
    Secondly the program has been put into place to acknowledge that introducing formula is a *medical intervention* that requires *informed consent.* that is what the information is for, that the parent (who chooses to bf) is informed of the risks of formula feeding, just like they are informed of the risks of vaccination, eye drops, circumscision, MRI or any other intervention a child may need. It’s not designed to “shame” mothers and as a resident of NYC I’m offended by your link to a hyperbolic article on the subject, rather than the actual information from the mayors office.
    Also the program does not require MOTHERS to sign a waiver anytime they want a bottle of formula, it requires MEDICAL PERSONELL to sign out the bottles and document them for mothers who have made the CHOICE to BF but are having difficulty.
    Mothers who choose not to bf or cannot and cannot afford formula are referred to WIC if they arent already signed up. Mothers who choose to use formula and can afford it are free to bring their own. Mothers who cannot simply have it documented on their babies chart.
    In writing this you are inadvertently supporting and perpetuating the idea that a parent should feel guilt for an important medical intervention a child needs. I hope that you will write a positive post that actually supports mothers, highlighting the importance of informed consent for those that are having dificulty BFing to insure that hospital staff do no feed their child formula wothout consent (an equally heatbreaking and common occurance) and that no one should feel guilty for doing what their child needs.

    • Melissa
      August 1, 2012 | 10:13 pm

      I agree with part of what you say, and here is the link to the formal NYC initiative http://www.nyc.gov/html/doh/html/pr2012/pr013-12.shtml.

      My point in this post IS to support all mothers. No, it’s not an uplifting story, but nonetheless a true one that highlights an important aspect of this kind of initiative. It sounds good on paper but what it translates to is a different story.

      I agree formula should not be pushed on expectant and new moms and moms should know the risks and benefits of anything they do for their child. Furthermore, giving an infant formula without a mother’s consent is absolutely wrong.

      My point is there is a price to pay when we start putting these things under lock and key and “informed consent” in this case does amount guilt and shame for many mothers.

      Should they feel guilty? No, absolutely not in my opinion. But the reality is (I’ve been reading the rhetoric around this so I know) these kind of measures cultivate a culture of judgment if we are not careful.

      And, I do speak about breastfeeding and formula feeding in a positive way.

      What I would like to see instead of formula lockdown and “informed consent” is a viable infrastructure of knowledgeable and trained personnel able to help women reach their breastfeeding goals and trained in recognizing and treating barriers to breastfeeding.

      Honestly, it’s such a strange culture we’re in right now…depending on who you talk to…some women are shamed for nursing in public, others for bottle feeding their babies.

      It really needs to stop. I want higher numbers of breastfed babies. I also want all moms to feel at peace whenever she’s feeding her child. However, and wherever that happens.

      • Megan
        August 1, 2012 | 11:35 pm

        I think informed consent is necessary. There are other choices for women who cannot, or decide not, to breast feed. There’s donor milk, as well a other options such as raw milk based formulas (http://www.westonaprice.org/childrens-health/recipes-for-homemade-baby-formula/#rmbf). These other options may not be popular, but families would benefit from knowing all their options. When you’re given lots of factual information to work with, it’s empowering. And, mothers feel shame all the time. If not because of formula use, than something else; usually out of our control. It’s very sad when a woman wants to breast feed and can’t. But, either way, choosing to go uninformed to avoid feeling shame isn’t a solution. I agree that government is over reaching, again! But, we all have the right to know what’s being given to our child, and to have the final say. No one should shame anyone here. I’m certain it happens. We live on a world where lots of things happen that shouldn’t. We have to do what is right for our child.

        • Melissa
          August 1, 2012 | 11:42 pm

          Well, this is all very true. Odd because informed consent for moms capable of breastfeeding is like a protection or safeguard but for women like me, it’s like a knife through the heart.

          I don’t know how to reconcile that. But again, I don’t think we should trivialize it.

          Moms should be informed of all options, yes. But more than that? Support, education, and knowledgeable staff instead of merely saying well “breast is best”. And it needs to go beyond the doors of the hospital.

      • Melissa
        August 2, 2012 | 5:29 pm

        Ok but there is no waiver!

        • Melissa
          August 2, 2012 | 6:24 pm

          I suppose it’s a matter of semantics. What you call “informed consent” is still asking moms to sign a paper acknowledging that she understands the risks of not breastfeeding and of giving her baby formula.

          • Melissa
            August 2, 2012 | 6:44 pm

            Your information is incorrect. There is nothing for the *mother* to sign. The only one signing anything out are the RNs and doctors, maybe LCs, entering their codes to get the bottle and documenting it on the chart.
            Please don’t base your information on the NY post! It’s notorious for being a glorified tabloid.
            Here’s a post from and IBCLC on what a similar program looks like in practice: http://phdoula.blogspot.com/2012/08/reply-turned-post-nightmarish-vision-of.html?m=1

          • Melissa
            August 2, 2012 | 7:42 pm

            You keep saying that, but even in this article you link to it says, “…the consent they have to sign…”

            They have to document that they have the mom’s consent, hence they need a signature instead of a he said/she said.

          • Melissa
            August 6, 2012 | 1:04 pm

            Please see the FAQS here where it clearly states “no written consent required”

            “Myth: Mothers who want formula will have to convince a nurse to sign it out by giving a medical reason.
            Fact: Mothers can and always will be able to simply ask for formula and receive it free of charge in the hospital – no medical necessity required, no written consent required.”

            I hope that you will consider posting an update for your readers.

          • Melissa
            August 6, 2012 | 1:12 pm

            It’s good to see that they’re responding to the criticism and updating the initiative guidelines. Thanks for sharing.

  15. AngelaI
    August 2, 2012 | 6:59 am

    Thank you for this great, personal article.
    I too tried to breastfeed my babies, but alas they needed more than I could give them.
    The worst part was the attitude and comments I got from my husband’s family.
    I try and make sure that all the women in my life who are thinking about formula because their baby need more, know that they are NOT alone and they are NOT making a wrong decision.
    (Wish more people would feel that way about c-sections too. Sometimes a c-section is necessary to save baby & mom and we did not take the easy way out)

  16. Mich
    August 2, 2012 | 7:43 am

    Thank you for talking about this. I never even knew what it was. But now I understand why I couldn’t breastfeed. It wasn’t from lack of trying, believe me. But when your baby LOSES weight instead of gaining it, and cries because they’re STARVING, you know, as a parent, that you aren’t doing enough for your child, and you need to do something different. I tried with all 3 of mine, but could only do it for about 2-4 weeks tops, before deciding that it wasn’t BEST for my baby. I don’t lecture people that DO breastfeed, I think *I* deserve the same for NOT doing it.
    Again, thanks for sharing this.

  17. Priscah
    August 2, 2012 | 1:37 pm

    For the first time I understand why I couldn`t breastfeed for long.My children cried from hunger until I unwillingly put them on the bottle.I have 4 and I stopped breast feeding before they were 9 months old or at 9 months.Same story for all of them.I thought I was the only one ho experienced this and I didn`t know it was a medical condition.Thanks for sharing .

  18. […] have birthed. It will make women who are unable to breastfeed (or who choose not to breastfeed) feel shame and guilt. One blogger for the NY Times characterized the effort as “an attack on parents and babies in the […]

  19. Jean
    August 2, 2012 | 9:35 pm

    Sweet MZ. That brought tears to my eyes. I remember those early days with Brandon. You are the BEST mama. Your kids are so lucky. xo

  20. […] Want me to sign a breastfeeding “waiver”?  I have a letter for you first.  {Confessions of a Dr. Mom} […]

  21. Susan Case
    August 4, 2012 | 9:27 am

    My daughter was a premie and I desperately wanted to breastfeed her – but was not allowed to until she was 3 weeks old. They barely let me hold her so I massaged her while she laid in her bed. When they finally did let me breastfeed her, she took to it naturally. I still pumped and she still needed some formula. But I was questioned as to why I thought she might have been premature, why did I hang around the NICU so much, why did I let myself get pregnant at age 39? (Actually, I had given up ever having a baby after 3 surgeries, a miscarriage and years of infertility). Most of the NICU staff were very kind and compassionate. But moms are extremely sensitive and tired right after birth and I don’t think we need more waivers, more questions, more made-to-feel-bad programs, more government intrusion. I’m a good person. I’m a great mom. I have a Master Degree. I know what is best for my child and what my body is capable of doing. My heart goes out to those who want to breastfeed but aren’t able. But they are still good moms.

  22. Jessica
    August 9, 2012 | 5:40 pm

    What an amazing doctor you must be for your patients Melissa. To have such compassion and understanding for all that they are going for and to be able to use that as you help them through mothering. They are all so lucky to have you.

    • Melissa
      August 14, 2012 | 11:40 am

      Jessica, thank you for such kind words. That really means a lot to me. I learn so much from my little patients and their families every day. I’m luck too :-)

  23. Lauren
    August 16, 2012 | 2:33 pm

    I don’t agree with making moms sign an informed consent, however as a doula I think people would be shocked at the amount of parents who say “we are breastfeeding, please don’t give a paci or formula” and their babies have been given those things anyway. Can you imagine what a slap in the face that feels like?! To specifically say you don’t want something given to your child and it’s done anyway. Not only that, but have you ever looked in a “breastfeeding gift bag” given to moms IN the hospital? It’s a can of formula!!! No soothie gel pads or cream for sore nipples, not breastmilk storage bags, but formula! I support women who choose not to or simply can’t, but all the “breastfeeding is shoved down my throat” stuff is getting old. Breastfeeding moms have formula shoved at them quite a bit…in the hospital, on tv, they’re asked to cover up, asked how much longer they’ll keep “doing it” and so on. There’s two sides to everything. Nurses and doctors want to ensure healthy babies, it’s their job. It’s not personal. Mothers should help care for other women by doing what they wanted done for them during recovery (come wash dishes, do a load of laundry, wipe down the bathroom counter, sit and okay with the older sibling, bring a meal) just leave breastfeeding or formula questions and comments out of it unless you’re asked.

  24. Lauren
    August 16, 2012 | 2:38 pm

    Right now, formula is an “opt-out” meaning you have to say I don’t want to. Since it truly isn’t the best for babies (like it or not) and it costs hospitals money, it should be an “opt-in”. I think maybe there’s a better approach than this one, but neither is leaving things the way they are