Tuesday, January 31, 2012

Getting Off the Medela Teat

(I am SO not really.)

By way of introductory comments, I first need to hail the revival of Just West of Crunchy, which was rendered out of commission by a terrible crash. Welcome back! Secondly, I'm going to point you in the direction of a Very Important Post: The Problems With Medela.


What's that you say? Problems? With Medela? But - they make breastfeeding products! They promote breastfeeding, right? And I love my slick Pump In Style. How can you have problems with them? 

Trust me, I understand. I was right there with ya. Here's the thing. I have my own post addressing my concerns about Medela, as some of you might remember, but JWOC's post is incredibly detailed and thorough (heck, I included a link in my own piece) and does a bang-up job of explaining why everything with Medela is not as rosy as it might seem. 

The issues fall into two major categories: Medela's very-much-intentional violation of the WHO International Code Marketing Breastmilk Substitutes (henceforth known as "The Code"), and Medela's very-much-intentional production of open-system, mold-vulnerable, single-user-only, landfill-destined pumps. I'd excerpt from JWOC's and my posts, but I'd end up excising them almost in their entirety, so please, go ahead and click through and check them out.

Why this is timely for me now: Here I am, in Boob School, knowing all of this . . . and turning around to distribute Medela nipple shields, and Medela hydrogel packs, and Medela Supplemental Nursing Systems, and Medela breast shells; and then there's Medela microwave steam cleaning kits, and Medela storage bags, and Medela sanitizing wipes, and on, and on, and on. I do it with an internal wince - but I do it. And this is definitely representative of many (I would venture to say most) lactation consulting environments. I would expect this in hospitals, as they rent out the Medela-manufactured hospital grade pumps (the only kind that are approved and safe to be used by more than one mother), but they're present to the point of ubiquity even in environments like Birthingway's clinic.

So I have to wonder: Is there any way to change this? Is Medela so pervasive that even among those who know about the Code violations and the worries about their pumps, ethical concerns have to be shelved because their products are so indispensable? We know about some other excellent pumps, of course. Other companies produce 'accessories' that are on par with Medela's as well - I've written to some of them to ask for samples for our clinic. Yet I feel like a stronger statement could be made by our profession as a group, if we acted collectively.

I'd love to hear from others working in lactation consulting environments. Are there any out there that are Medela-free? I genuinely do not know. Are they in private practice? Or might there be any Medela-free hospitals? What about hospitals that qualify as Baby-Friendly? What is their position on accepting and promoting Medela products? The Baby Friendly Initiative was started by the WHO (in conjunction with UNICEF); it would be odd to me if a Baby Friendly hospital were to distribute products made by a Code-violating company - but again, I don't know one way or the other.

Can we start talking about this?

One last thing: Another excellent post on Medela was written by PhD in Parenting. It's linked to in my own original Medela post, but it's worth mentioning again here, not just because it's great but because many of you (especially if all this is new information) might be wondering what the big deal is. Okay, so they're not perfectly perfect, but why spend time attacking Medela when the formula companies are the real culprits? I think she summarizes the objections to criticizing Medela so well here:

I don’t want to be overly critical of Medela. I think the company does a great job promoting and facilitating breastfeeding. Most of the information on its website is wonderful. Most of its products are of the highest quality. I have been nothing but happy with my Medela products. However, I do think that some of their current actions to promote their bottles are inappropriate. It would not be difficult for Medela to continue to promote breastfeeding and sell its bottles without promoting them. However, it has chosen to ignore the WHO Code and push more bottle imagery and bottle messaging on moms (more on why bottle imagery and messaging is hurtful here). The result is that Medela is directly pushing bottles on moms and also doing so indirectly via the Medela Mavens and others who might pick up on the message about how breastfeeding ties you down, so you really need a pump and bottles so you can get your hair done.
 To be clear, on a sliding scale this is not even close to Enfamil or Nestle or other formula companies. Not even close. But I would argue, and others do argue, that any violation of the WHO Code weakens its potential impact. We cannot say “it’s okay because you are Medela,” but then slap Nestle on the hand for everything it does wrong.


14 comments:

  1. I don't have solutions, just a few observations from my region. I'm a childbirth educator & peer lactation counselor in WV, USA. There are no Baby-Friendly hospitals in my state. Few stores even stock Medela pumps (maybe Target? Or maybe just target.com), most are crappier. That means for most moms here, they register for whatever is available. Few will track down something from a boutique in another state. They buy what's available. Supply and demand-- we need to demand Ameda & Hygeia pumps in Walmart & Target. (Are they both still Code compliant? I'm sleep deprived & can't look it up.). Also? I've contacted both Ameda and Hygeiea multiple times by phone and by email to ask for promotional brochures on their products & pumping, to put in clients' take home folders. Neither company has sent me any, nor even bothered to reply. When I called Medela, they sent a huge box of 6 or 7 different types of brochures. I know they're not Code compliant, but 1) it's what locals buy anyway, 2) Ameda & Hygeiea won't send brochures.

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    1. Huh, I am REALLY disappointed to hear that. I did get responses from both myself, but still, they should be responsive to everyone. Sorry you had a bad experience - I hope they get this feedback and make changes accordingly!

      And I totally, totally get the accessibility part of the problem, for sure.

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  2. Ameda and Hygeia both make hospital-grade pumps, too. I'm not sure how much reach Hygeia has at this point, but at least one of our local hospitals uses Ameda products for inpatient (and then rents Medela for moms who need a rental, so there's that...) The hospital where I did my lactation internship was both baby-friendly and all-Medela.

    Babies'r'us carries Ameda product, at least in my city. Medela has the better shelf positioning, but it's slowly shifting.

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    1. That's good news to hear! Glad the shelving seems to be shifting in your area. And if ONE hospital carries Ameda pumps, no reason others can't!

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  3. @Sarah It might not seem like it, but there's a huge expense to sending promotional brochures and free samples. It's nearly impossible for companies who don't have large marketing budgets to compete with the volume of free samples and brochures that Medela can afford with its near-monopoly on the pump market.

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    1. A fair point as well. Still, it sounds like there was no response at all, If I'm reading correctly, which seems like the larger problem.

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  4. As I've written before, I struggle with this...I dislike the ubiquity of the PIS as the pump that "everyone" buys, mostly because of the issues that newer PIS pumps seem to have with longevity and the SERIOUS potential issue of mold, and because of Medela being a code violator in their consumer marketing.

    But on the hospital-grade side of things, there's the Symphony. Everyone loves it, it's so quiet, it can be turned down to be very gentle, the suction is smooth, etc. I work with some moms who can only get milk out/pump comfortably using the Symphony. It's much simpler to swap out flange sizes (and can I say how much I dislike Ameda's "insert" system to change flanges?) I don't know what the solution is here. There are absolutely other good pumps out there and mothers can establish and maintain a supply with other brands' hospital-grade pumps. And I've never even seen an Ameda Platinum pump which is their top-of-the-line hospital-grade pump - maybe people would like it as much as the Symphony. But it's a hard machine to beat and it's doubly hard to compromise when you are talking about moms in very vulnerable situations with premature infants.

    FWIW, I imagine there are definitely Medela-free hospitals out there that have an exclusive contract with another company (probably Ameda). Our hospital is trying to pick a brand and when we do, we'll have an exclusive contract with one company for all materials.

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  5. I believe part of the issue has to do with the poor status that lactation consultants have as allied health professionals in this country (with little insurance reimbursements, etc.) Many private practice consultants have had to add retail business to their practices just to stay afloat. They've sold Medela products for years, well before they were non-compliant. Now, they have their livlihood so wrapped up in this company that to disengage would be serious financially. We must continue to push for licensure and good reimbursement for our profession.

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  6. So I am going to share my thoughts. I am a new mother of chow-hound 4 month old. This may cause a little bit of an uproar.

    First of all, I agree with the idea of cutting back on bottle marketing. There should be more pictures of breastfeeding. There needs to be a more willingness to show these pictures. Its so beautiful and such a wonderful experience.

    However, to share a little of my own story. I went into having a baby, knowing I wanted to breastfeed. However, after a battle with cracked nipples the first month, than little episodes of mastitis and about 2 and half months of thrush. My milk supply had been depleted. When I finally gave in and gave my baby formula, I was devastated. And to this day I am still both nursing and bottle feeding. And taking fenugreek to boost my milk supply. I WANT to breastfeed.
    What I have a problem with is this code prohibits giving free samples. I have greatly appreciated the boxes of Similac and enfamil that have come my way. I know that is not the companies addressed here but running a company is not easy. Even large companies are at risk. The fact the Medela has provided me with so many free samples, like nipple shields, which gave me strength to continue the first month. The reusable breastpads, which make the it easier that trashables. I believe in breatfeeding. I don't however think it is right to blame companies for not obeying a code which just keeps it from helping and blessing there customers.

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  7. The hospital where I gave birth to my daughter uses Ameda hospital-grade pumps, and I subsequently bought an Ameda for when I went back to work (and then my sister used the same pump when she went back to work after having her daughter--something that wouldn't have been possible with a Medela). I've had only good experiences with Ameda, and I wish more women knew about their products instead of immediately turning to the Pump in Style.

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  8. Thank you so much for calling attention to this issue. As breast feeding ever so slowly creeps back into our culture we will continue to have to monitor our growth and direction. Thank you for calling Medela out on their lack of dedication to one of the few governing agencies that protect breast feeding. Hopefully Medela will get their head on straight and remember the mothers and babies that they claim to serve. As studies continue to be turned out about how it is not just breast milk but also being at the breast that offers the most benefits hopefully we will continue in the right direction as a society in spite of corporations and the medical industry. Thank you!!

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  9. It's very sad to see all the misinformation about Medela. The same Medela whom actively funds continuing research into breastfeeding science with leading experts in the field! Ask your friends at Hygeia and Ameda if their products are research based. Ask your friends at Ameda and Hygeia if they pump millions of dollars into furthering our understanding of lactation, breast anatomy, hospital best practice, expression, human milk prep, etc., etc. THEY DON'T! The fact of the matter is, Medela puts its money where its mouth is. No other pump manuf can even come close to that claim. And let me address the whole WHO Code issue--Medela felt it was necessary, and their responsibility, to make sure moms were aware that their teats and bottles were BPA-free...yes, through advertising. The fact that Medela believes in transparency of its product marketing put it into conflict with those who interpret the code. Medela does not glamorize bottle feeding as it relates to formula feeding--that's simply absurd. Medela should be applauded for saying to organizations like NABA, we will NOT compromise our commitment to moms to simply be labeled 'compliant.'

    A couple of important points to combat all the fallacies floating around: THERE IS NO SUCH THING AS A "CLOSED SYSTEM." All pump manufacturers are limited by their kit configuration, which must vent air to regulate pressure and vacuum. Ameda's and Hygeia's kits are BOTH open to the ambiant air. In addition, you do realize that Hygeia designed its pump on the expired patent of the Medela Lactina pump, right? Yeah. Medela is already a generation advanced from Hygeia and Ameda, neither of which utilize research-based, 2-phase pumping.

    Finally, I gotta say, it's disheartening to realize that people believe whatever their told, or read. Medela has done more to advance the promotion of breastfeeding than anyone else. That's a stone cold fact! And despite the label of 'violator' Medela continues to honor its moms with research-based product, superior support, truth in advertising, and knowledge.

    Having had 2 children of my own, and breastfeeding both I might add, I have tremendous respect for Medela and all they do to support moms like me!

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  10. Ladies and gentlemen, we have a Maven.

    Look, again and again I point out that Medela is nowhere near as egregious as formula companies. They are not an "enemy". And I've quoted others who feel the same way. But there is no reason they shouldn't be called out for the things they ARE getting wrong. YES, they do fund breastfeeding research, This is not a secret. It is also discussed as a double-edged sword, at least among lactation pros. Would you accept research comparing the benefits of expressed milk to direct-from-the-tap milk that was funded by a pump company? If so, I have a bridge to sell you.

    Secondly, my Advanced Skills class just dissected a number of pumps, including Medela, Hygeia, and Ameda, among others; both hospital and home versions. I stand by my statements, and the info that JWOC shared is still relevant and accurate. And the thing about Medela violating the WHO code due to BPA concerns: Because there's no other way to let consumer know that their bottles are BPA-free? Come on. I have a hard time believing anyone would actually swallow that excuse. (Though I can imagine the meeting where their PR department came up with it.)

    Third, that you would call this a "stone cold fact" is kind of impressively belligerent, when you consider the impact of organizations like LLL and the WHO. Really? MEDELA has done more than either of those organizations to promote *breastfeeding*? Medela needs to field train its mavens a little more carefully. That's just a ludicrous statement.

    Finally, if you've read my blog for long, you know that I EPed my daughter for the first 5 months of her life via a Medela pump. Trust me when I say I understand emotional conflicts when it comes to such a touchy subject. But, I repeat, this sentimental connection and the fact that they aren't mustache-twisting villains does not make them above reproach.

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  11. I saw an IBCLC in St. Louis, MO that is Medela free. I rented a PJ's Comfort pump from her for several months- so much better than the Medela products I've used in the past.

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