1. Bickings, Valerie MSN, RN, ARNP

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In my opinion, the trend toward formula-free postpartum units is impractical, unnecessary, and contrary to how we provide family-centered care. It is understood that this trend is an attempt to increase the incidence of breastfeeding and encourage women to exclusively breastfeed until their infants are at least 6 months old. This is a worthy goal!! However, in the United States, where all formulas marketed must meet specific nutrition standards (Morin, 2004), where water purity generally is not an issue, and where the availability of high-quality infant formula is sufficient, mothers should have a choice when it comes to deciding about infant feeding. As nurses, we know that breastfeeding is optimal for newborns; however, commercial formulas have been around for a long time, and many newborns have been lovingly nurtured and have thrived without ever having had breast milk. Formula is the only alternative to breastfeeding that is nutritious and safe (Baker, 2003).


Mothers who have specific rationale for using formula-perhaps for medical reasons or personal preferences (e.g., the HIV-positive mother who has a high viral load, the mother whose attempts at breastfeeding with a previous pregnancy were not successful, maternal or infant anatomical difficulties, the newborn placed for adoption)-may be made to feel inadequate by the nursing staff in choosing to formula feed. "Breast is best" is a phrase frequently used by nurses in the postpartum units with which I am familiar. Mothers may infer from this phrase that formula feeding is second best when, in fact, it may not be. Recently I had the experience of talking with a new father visiting his wife on a postpartum unit. He mentioned that he had to "hide the formula purchased from the store because the nurse made them feel so guilty" for using formula. He and his wife were concerned that their newborn son was not receiving sufficient nutrition from breastfeeding, because the mother's milk was not yet down and their son did not seem to be satisfied after breastfeeding. They made the decision to use formula in order to do what they felt was best for their new son. If formula had been available on the postpartum unit and if the nurses had been supportive of the parents' choice, these parents may not have suffered feelings of inadequacy and guilt related to their actions.


Establishing partnerships with families, a core principle of family-centered care, means that nurses and other healthcare providers need to inform parents about infant feeding and encourage and support them in their decisions. Nurses need to respect the choices mothers make in relation to infant feeding, and hospitals should be supportive of their choices. This means that nurses should be available to advise mothers and teach them about whichever feeding method they have chosen; hospitals should provide formula to facilitate choices that mothers make.


I have learned through my experiences that many mothers have already decided on a feeding method before the delivery of their infants, and those who choose formula feeding have purchased supplies so that the transition from hospital to home is smooth. Because most feeding method decisions are made in the prenatal period, it would make sense to educate women during their prenatal visits about the important effects of breastfeeding and strongly encourage them to consider breastfeeding. However, attempting to alter the decisions of women who have chosen to formula feed once they have given birth by not having formula available on the postpartum units is not good nursing practice and certainly does not place the family at the center of our care.


Formula feeding remains an option in this country, and hospitals should realize that having formula-free postpartum units disregards the decisions some women make regarding their infant's nutrition. Until formula feeding is determined to be unsafe, postpartum units should not be formula free. Most of all, as nurses, we must be therapeutic and family centered and respect our patients and their choices. We are here to enable and empower, facilitate autonomy, offer advice, and educate and support families in whatever choices they make.




Baker, R. (2003). Human milk substitutes: An American perspective. Minerva Pediatrica, 55, 195-207. [Context Link]


Morin, K. (2004). Safety and infant formula. MCN The American Journal of Maternal/Child Nursing, 29, 326. [Context Link]