Monday, February 1, 2010

Ready, Set, Suck: On breastfeeding marketing & Medela's WHO violations

It came to my attention not too long ago that Medela, probably the largest manufacturer of breastfeeding-related products, might be less than squeaky clean in terms of their compliance with the very important WHO Code regarding marketing of formula, bottles, and other breast & breastmilk replacing products. But I managed to coast along in denial for a while longer, having had Medela products play such a huge role in my daughter's long and exhausting road to the breast.

Their high quality, extremely efficient Advanced Pump in Style double electric breast pump was what got Lily fed, period, for the first 5 months of her life, while my LC and I worked at various strategies to get her to latch. Using the SNS was an important step we needed to take along the way (though I ultimately found the Lact-Aid to be superior), as were their nipple shields. And primarily because I became emotionally invested in them, I also purchased accessories like their breastmilk storage bags, breast shells to help draw out flat or inverted nipples (and to air-dry them if sore or healing), their travel wipes for the pump, and the microwave steam cleaning bags. It’s convenient when the pump you’re using fits with the bottles you want to use, when replacement attachments are readily available, and when you feel like there’s a consistent quality there that you can trust. I completely understand that kind of brand loyalty.

Because I was such a loyal customer, it was all the more stinging to read this post by PhD in Parenting last week, full of serious truthiness as it is. I won't rehash the entire thing here, as she has done such a good job already, as did the above much earlier post from Hoyden About Town - do go check them out for yourself. Suffice it to say that not only has Medela flipped the bird at the code, marketing bottles in violation, they're now making matters even worse with this sly, underhanded "Medela Mom Mavens" campaign.

I can understand, to a degree, that it's a tricky line to walk at times. Having some of these products available, like the ones my daughter and I benefited from during our insane nursing saga, is important. They should be available to moms who need them, and easily so. I am thankful that when I needed a different size nipple shield, I was able to run out to the local big box baby store (more on that in a sec) and pick one up. I'm thankful that replacement attachments for the pump were similarly conveniently available. I am thankful that the moment it seemed like my situation might call for an SNS, my LC was able to hand me one immediately. Such breastfeeding support products can make a HUGE difference in breastfeeding success when there are complications. As Annie at PhD in Parenting says:

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.
Lines have been crossed, not only in the clearer terms of promoting their "breastmilk bottles", but in the more nebulous grey area of promoting products over breastfeeding. I've been mulling all this over for a few days, and trying to find a way to put that thought into words, and then I went to the big box baby store yesterday, a trip that was disappointing on two levels.

I was there to drop off some flyers for the upcoming doula training I'm sponsoring, as well as some business cards. The last few times I was there (hey, pickin's are slim in this town), probably 2 months ago or so, there was a small table behind the registry area where local birth and baby-related services could leave their materials. There was never a lot, but there was a brochure for an independent childbirth class, cards for a breastfeeding support group, a small calendar of mom's playgroup activities, that kind of thing.

When I walked in yesterday, the table was empty. I asked an employee whether it had moved, or if there was another area to post about things like childbirth classes - a community message board, perhaps. She told me that no, they had decided to not allow outside materials any longer. Disappointment #1, in terms of small businesses and independent agencies. But hey, she said, they have some classes of their own! She pointed out the board below:

Here's a closer look:

A "Breastfeeding 101" workshop, sponsored by You Know Who! A basics of breastfeeding class whose description begins with "Ready, set, pump!"

If that doesn't make their priorities clear, I don't know what will. Believe me, I know firsthand that a pump is sometimes absolutely essential. And certainly it is for mothers who work outside the home. Hallelujah for them, seriously. But a breastfeeding class that focuses first and foremost on pumping? The rest of the description: "Get the scoop on breastfeeding and all the great products sure to make it easy to feed baby naturally." I mean, it's not that I was surprised to see a live, in-person infomercial for Medela products disguised as a breastfeeding "class". Especially not at a big box store (with similar classes in car seats, sponsored by Graco, and the like). I'm not so naive. Just very, very disappointed.

So, like many other lactivist moms out there, I can no longer in good conscience continue to promote Medela products. So what to recommend in its place? Just West of Crunchy has an excellent and thorough post on the matter, which starts out bemoaning the same state of affairs and then goes on to explain the Hygeia and Ameda pumps, both of which sound great - in addition to being WHO compliant, and proudly so, unlike some people, they are also closed system pumps, much preferable to Medela's open systems. She explains it all adeptly here:

If more mothers knew the facts about their beloved Pump in Style pumps, Medela would be selling a lot less of them. And I can speak from experience, I have a PIS sitting in my closet, waiting to die a slow death in a landfill.

Why? Because it can't be given to anyone else. That's right, my $280 breastpump has to be tossed in the trash. It's not FDA approved for more than one user. Even though I only used it maybe 30 times. And I know there's a huge black market for the sale and donation of used single-user pumps, but you know what? Even if I could, I wouldn't give the thing away to another mom. Because once you know the facts on the Medela pumps, you won't want to use them.

There are "closed system" pumps and "open system" pumps. Medela is the latter. Having an "open system" means that milk can contaminate the tubing and the motor to the pump. And while the tubing can be cleaned or replaced, the motor cannot. Which means if my milk makes it into the motor, so could a hypothetical seccond user's, at which a time they'd mix. The motor can't be cleaned or sanitized, and there's no way to know if milk ever contaminated it. So, if you're using a second-hand pump, it might be clean, or it might not. Your guess is as good as mine.

But even if you follow the rules an purchase a new Medela pump, keep it, and never allow it to be used by a second party, you can still have problems. It's important to note that Medela is completely open about their pumps being single-use only, they're very forthright about that. The information that's lacking, though, is that you can actually end up with MOLD in your pump motor and tubing, due to the open system design. The milk that you can't see in the motor - that you have no way of knowing whether it's there or not - can grow mold inside your pump. You can also end up with mold in the tubing (a lesser problem, as that's replaceable).

I don't know about you, but I'd rather have a pump that has ZERO chance of developing mold in its motor. Both Hygeia and Ameda offer pumps that have closed systems. You're not going to get milk in them, because the way they're designed, there's no backflow. Not only are these WHO Code compliant companies, they make superior products!

I took a look at Big Box Baby Store's pumps to see if they had either of the above. Nope. [See update below!] They had one Lansinoh electric pump, and one Evenflo hand pump, and the rest was, of course, all Medela, all the time. So, it's frustrating. Medela is no doubt the most widely available. You can go see them for yourself, talk to a salesperson, and take one home the same day. Ordering things online is less appealing and even prohibitive for some people. But I have to recommend doing so nonetheless, at least until/unless Medela does a serious 180 (and I would be thrilled if they did). If you're lucky enough to live in an area with smaller businesses that might sell alternative pumps directly, then hooray (for that among other reasons).

What about some of the other products, though? Smaller ticket, yes, maybe not as big a deal to the company, but still. I can make a few recommendations. For the best storage bags: I always liked Lansinoh's. And I honestly would recommend the Lact-Aid over the SNS even if Medela was behaving ethically - same basic concept, but the difference in user-friendliness is HUGE, and again I must point out that Lily would NOT be nursing today were it not for the Lact-Aid - along with the brilliance of my LC of course. But I digress: As for nipple shields, that's one where I'm stumped. Breast shells as well - I know that for drawing out inverted nipples, Supple Cups are now available, and reputed to be very good, but for helping to air-dry sore or wounded nipples, I'm not familiar with an alternate brand. Lactation pros, moms with nursing challenge experience, do you have any ideas? Please chime in.

I close with the following from the Hoyden About Town piece, on the insidiousness of Medela's current marketing:
[Medela's commercial states:] “When you choose to breastfeed, you’re doing what’s best for your baby. When you choose Medela breastfeeding products, you’re doing what’s best for you both.”

Medela is saying, directly, that breastfeeding is not best for women. It might be ok for babies, sure, because they get the breastmilk, but Medela is telling us loud and clear that pumping is better for mothers than breastfeeding is. No qualifications, no circumstances; just “pumping and bottle-feeding is best for women”, with a side serve of “and it’s just as good for babies”.

This isn’t just a WHO Code violation; it’s not true. And it’s a lie fed by all of our dysfunctional societal issues around breasts and breastfeeding and public feeding and mother-child attachment and women and the workplace. It’s fed by the huge pile of myths about how easy pumping is, and about how bottled stored breastmilk is just as good, and about how it’s vital to schedule feeds and “see how much babies are taking”, and about how babies don’t know when they’re hungry or thirsty or full or in need of comfort. The problem is, it isn’t just fed by those dysfunctions, it’s feeding back into them, reinforcing them.

These sorts of advertisements are part of the huge coercive societal mechanism denying support for mothers and children, part of the capitalist machine preventing women from being able to afford time with new babies, and keeping them being good little workers and consumers. I think it’s no coincidence that two countries with no moves towards a full legislative implementation of the Code, the USA and Australia, are also the only two industrialised countries in the world without mandatory paid maternity leave.

Words mean stuff. Marketing is powerful. Advertising works.

And it makes a whoooole lot of money.


UPDATE 8/31/10: Ameda pumps are available in Babies R Us nationwide now, and not only that, the Lansinoh double-electric pump for $150 is actually an Ameda pump, rebranded, and at half the price.

*The hospital-grade pump Symphony pump IS a closed system, so this is the one exception in the Medela line, ethical issues notwithstanding. Moms needing to rent these when there's not an alternative brand available should feel safe.


  1. I've been thinking about this lots since you posted the pic on FB. As you say, there's definitely a place for pumping and such, but their assertion that breastpumps and products are part of "Breastfeeding 101" really gets to me. Breastfeeding 101 should involve baby, breast and a whole lot of support.

  2. I think people are being too touchy. There is more to breastfeeding, for a lot of people, than just putting baby to the breast. In fact, if you've never been to this class, then I think you are jumping the gun by criticizing it. Medela is the ONLY place around here (and they are located in the next town over from me) that continually encourages moms to breastfeed...and feed their children breastmilk. I would be horrified if they put breastfeeding 101 and then touted the wonders of forumla for those "hard times". But, they do not. They are giving women the tools to give their babies breastmilk. I know quite a few people in my community who balk at breastfeeding, but are fine with pumping and feeding breastmilk through a bottle.

    I also find it strangely disturbing that there is this much of an uproar over Medela marketing their pumps and bottles (even thought the people who use them either will not or cannot breastfeed) and there was no uproar over companies, like Playtex, who started making and marketing their own breast pumps (which at best were uncomfortable and at worst a truly horrible product).

    How sad.

  3. I understand your misgivings, I really do. That's why I struggled with it for a good while, and wanted to ignore it because of the good that they DO do. I thought Annie put it perfectly in her own post, to quote again - I agree with her on all counts, including the positives:

    "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 . . . 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."

    And there has indeed been much uproar over Nestle's practices.

    I want to like Medela too. And I definitely did. These changes in policy are recent, and it's my opinion that they are unfortunate. Is it as bad as sending formula samples to developing countries? Of course not. But not only do I have a problem with actively promoting bottles, I do think it is problematic to imply through promotion that pumping is superior to normal breastfeeding.

    For moms who cannot (and remember that I was one of them for a long time, and could have had to do so permanently), products and info need to be available, there is no argument. Until very recently, Medela sold their products (the exact same ones) in a way that was totally in line with the WHO Code. It's a big leap from that to commercials like the one linked in the Hoyden About Town post.

  4. I am with you in WANTING to like Medela...I like their products a lot. And I like that at least they are promoting something related to breastfeeding as opposed to straight-up formula marketing. you I am not OK with the direction they're going in. This is the problem with no one having a vested commercial interest in breastfeeding. There is just no way to make big $$$ on every mother who decides to breastfeed her baby. Medela doesn't market or support breastfeeding; they market and support breastMILK feeding, and there is a difference. To the point, as the posts you link to illustrate, that they are putting down breastfeeding in order to elevate breastMILK feeding. And they're not the same - if nothing else, as you pointed out in your "nursing saga" it's much harder to continue pumping for an active toddler than it is in the early months. If we want to encourage extended breastfeeding, it needs to be just that- breastfeeding, not breastmilk feeding.

    It's a slippery slope, too - today, they're marketing bottles, tomorrow, they have their own line of formula? I agree that the solution is to express to Medela that we'd like them to return to their recent good business practices. The hospital where I'm training has now stopped purchasing Medela pumps because of their code violations, and Ameda has been delighted to pick up the business.

  5. That's funny about BRU. I went a few weeks ago to see if I could set up a "Choices in Childbirth" program or at least drop off some business cards. The store manager told me that they don't have workshops anymore, something about liability. Maybe implying that they could sued over info that someone gave out. They must be making the move towards insider corporate sponsored ones as well.

  6. I think the problem is that there is a difference between breastfeeding and feeding your baby pumped milk in a bottle. Despite what Medela might have you think, it's NOT the same thing. You lose some of the benefits of breastfeeding when you bottle feed, even if it's breast milk in the bottle.
    That said, it's sad that a company that is predicated on supporting women who want to breastfeed can't be bothered to support the Code, which was created to protect it. If Evenflo, a BOTTLE COMPANY, can be WHO Code compliant, why can't Medela? Great post!

  7. Great post. Marketing is so insideous we can't take violations lightly.

    FYI, I chose the Ameda double electric pump (ordered on-line) because of the closed system. I also ordered an extra set of bottles and, the carry bag and cooler set. Ten months of pumping 2-3x per day, 5 days a week and the pump is still holding up well. I have only replaced the valves once.

    I read a product comparison after buying the pump that explained the Ameda is marketed under the Lansinoh brand at a cheaper price and can be found in some big box stores. So if anyone is looking, that may be a good, affordable choice.

  8. Olivia: If you're looking to specifically recommend Code compliant companies, Lansinoh is now a wholly owned subsidiary of Pigeon, which is a big Code violator.

  9. lauredhel -

    TARNATION! Lansinoh, too? And this just after I learn that Ameda's parent company is Hollister, Inc. Also known as the manufacturer of the Plastibell circumcision instrument. *headdesk*

    That leaves Hygeia. Hygeia, you're our only hope. Please don't let us down!

  10. Did not know that about Lansinoh! Shoot, anybody know of other storage bags besides Medela and Lansinoh?

  11. People seem to like the Mother's Milk Storage Bags a lot:

    They have a wire at the top so you can roll & close them tightly.

  12. Ameda and Avent both make nipple shields. I used nipple shields with my premature daughter and there was another brand that I used, and the name escapes me. But there are other kinds available, although sadly they're probably not as widely available.

    I have been a fan of Medela in the past, but they are losing me. That class is the straw that broke the camel's back. I find the idea of a breast pump company sponsoring a class on breastfeeding to be inappropriate. If a sponsor is absolutely necessary, couldn't they find a nursing bra manufacturer, for instance? Or someone who makes nursing pillows? Not that a nursing pillow is necessary, but it is completely neutral on the code.

  13. Very interesting....I taught the breastfeeding classes at BRU for free for at least 10 years, out of the blue I was told my services where no longer needed. Now I have customers come in and tell me they took a BF Class at BRU and all they talked about were their products, nothing else. A store employee gave the class. How can they advertise "get the scoop on breastfeeding"??

    I am disappointed in Medela sponsoring this class and also our BRU misleading customers into thinking they are attending a breastfeeding class when they are not.

  14. It saddens me to see the BRU class, for certain. I will say, however that I am also very troubled by the code itself with regard to bottles/nipples and how companies like Evenflo and Ameda go about becoming compliant after violating the code (by jumping through a series of hoops set out by a review panel). It is my understanding from reading the code that any company that manufactures bottles or nipples is in violation.

    It is still critical for moms that work outside the home to pump, even when we nurse when we are with baby. With my first born I was working and I pumped for a year. I am now at home and tandem nursing, only pumping to donate to our mother's milk bank. I'm probably overly sensitive on the topic, but I have a hard time not taking some of the comments condemning bottle feeding pumped milk as a condemnation of women working in general.

  15. Wow! I almost had a total freak out! I've done so much research on pumping and everything I've read told me that the Medela Symphony was the best thing for induced lactation. Then I read that the FDA considers ALL breast pumps to be single use, no matter what manufacturers say. I also found out that the Symphony, as all hospital grade pumps, is a closed system. I think that should be noted in this article because some, like myself, might think you are speaking about ALL Medela pumps. Still, for portable pumps, the open/closed system is something to think on. Even if I still have to buy a new one (per the FDA), I'd rather not have a mold problem. Now, my only problem is, what is a viable alternative to the pump in style? Most people, including yourself, LOVE that pump. Please help me. I am breastfeeding an adopted baby (with the Lact-aid system that I am SO glad I compared to the SNS before purchasing either). I'll need to pump after feedings and when they miss feedings. Please, please help me and recommend a closed system that is just as good as the pump in style.

  16. Ariel, first of all, *highfive* for inducing lactation with an adopted baby. That rocks so hard I can't even overstate it.

    And you know what, that's a fair point to make the distinction regarding the hospital grade pumps (versus commercially available retail ones) clear in the post. The ethical issues around the WHO Code remain, but at least the system itself is safe. Done!

    And finally, I have read and heard very, VERY good things about both the EnJoye by Hygeia (the EnDeare is the hospital grade one) and the Ameda Purely Yours.

    The very best to you!