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    baby drinking from a bottle

    Inside the Infant Formula Shortage

    What does the mother of a preemie do – and think, and feel – when the supermarket shelves are empty?

    By Rachel Cañon Naffziger

    June 17, 2022
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    • Aunt Rebecca

      I didn't realize the harrowing experience continued so long after the time in NICU ended. Thank you for sharing from the heart.

    What I could give my baby was never enough. Not because I couldn’t produce my own milk – I did, thanks to a hospital-grade pump that mimicked a baby when mine was too weak to be held, much less nurse. The night after Santiago was born six weeks premature, I had to pump every three hours while on an anti-seizure medication – I could barely move and couldn’t see clearly, but the nurses were determined for me to get as much milk as possible. Breastmilk is, among other things, helpful in preventing necrotizing enterocolitis, an intestinal infection that can be fatal to preemies.

    But babies born so early and weighing less than four pounds also need extra calories, protein, vitamins, and minerals that no mother’s body alone can provide. In the first days my son received donor milk through a feeding tube, supplemented with a specialized human milk fortifier from Similac. Every day I brought in a bag of tiny containers of milk that I had pumped in the preceding twenty-four hours – seven times, thirty minutes each, not including time spent washing and sanitizing pump parts and labeling bottles.

    It was a painful process: I had mastitis, and often insomnia. I had been admitted to the hospital a month before his birth for severe preeclampsia (an increasingly common condition in the States) and partial bedrest is, ironically, exhausting. I was hardly able to walk before they surgically removed my baby from my body. I was beyond exhausted and becoming depressed.

    Thankfully, one of the NICU nurses noticed, and told me it was okay to sleep six hours between pumping sessions. Maybe I wouldn’t get as much milk, but Santi needed a healthy mom. The rational side of my brain accepted this, but postpartum depression left me feeling guilty constantly. Still, my body didn’t care; I slept through the alarms I had set to get up and pump more.

    baby drinking from a bottle

    Photograph by Nathan Dumlao

    Somehow I still ended up with a full supply. I was lucky – many mothers of preemies are also taking care of other children, live hours away from the NICU, or have to work so that they can use their leave once the baby is home. Preemies are less likely to breastfeed than term babies, and preemies born to young, socioeconomically disadvantaged mothers, who are disproportionately Black, are even less likely. Even mothers of term babies in the United States are unlikely to breastfeed exclusively until six months, the official recommendation of the American Academy of Pediatrics. According to the CDC, nearly six in ten babies nationally are still breastfeeding at six months, but only one in four are breastfeeding exclusively. Illness, latching issues, and lack of support for the mother are only a few of the reasons this happens.

    I had plenty of lactation support, but nursing is hard work for a preemie and Santi was exhausted. He hardly had the energy to drink half an ounce from a bottle. By the time he was able to build the stamina to eat without a feeding tube, he was accustomed to the flow of a silicone nipple and frustrated by nursing. After two months, he finally came home.

    The hospital had me supplement my pumped milk with Similac’s Neosure formula. But this, at $25 per thirteen-ounce can, was $7 more than even brand name standard formula. Thankfully, we qualified for Medicaid and WIC (a supplemental nutritional assistance program for women, infants, and children). My husband, who is Colombian, had lost his ministry job – and therefore his work visa – due to lack of funding, and couldn’t legally work until he received a permit through our Green Card application. Thanks to Medicaid, our $32,000 hospital bill disappeared, and thanks to WIC, I was allotted ten cans of formula (worth $250) per month. Maybe in the past we would have been embarrassed to go from being the helpers to the helped, but we were too relieved to care. When we moved and my pumping schedule became difficult to maintain, I didn’t have to worry about an extra formula bill.

    This specialized formula required a prescription from the doctor, which I gave to the WIC clinic, which then added the benefits to my card. When I had the prescription for Neosure it was the only formula I could purchase with WIC benefits; I couldn’t buy Similac or Gerber’s equivalent preemie formula. Even standard formula through WIC has to be from Enfamil, Similac, or Gerber, who have exclusive contracts with the government. You can only purchase the powdered form, so I also had to start purchasing gallons of water to mix with formula. Our building in Chicago was built in 1925, so while we await results from the free lead test I requested from the city government, we’re trying to avoid poisoning our baby.

    When I got my ten cans, I hid them in the back of the car, knowing that having $250 worth of formula visible could result in having my window broken.

    In early April, I kept checking the formula aisle expecting to find Neosure somewhere. There was plenty of lead-free water, but none of our formula to mix with it. So I started to call around. The conversation I had with each clerk was predictable: Similac has been recalled, maybe call tomorrow? Though I knew my particular type of Similac formula wasn’t affected, I learned to not argue my case. It didn’t matter. The shelves were empty.

    Finally I found twenty cans at Target. I felt a rush of relief as I placed ten cans in my cart; I’d never seen so many in one place. But when I swiped my WIC card at the register, it didn’t work. The cashier tried punching in the number manually. Still nothing. A line of exasperated students grew behind me. I handed the cans back to the cashier. Once I was alone in the elevator to the parking garage, I yelled at the closed doors with all the force of the anxiety, anger, and fear I had felt in the NICU. It didn’t help. When I got home, I walked around the block to calm down before going up to our little apartment; our smiley baby wouldn’t understand that I was angry and frantic. I was afraid I couldn’t feed him.

    I called more stores. From another Target I learned that the particular store I visited didn’t accept WIC, most likely because they cater to students. I finally decided to try calling the WIC Grocery Center, a store that only serves WIC recipients, forty minutes away. They had plenty; apparently they have a different supply chain. As I drove there, I thought about other moms of preemies in my neighborhood; did they know it was here? How many buses would they need to take if they didn’t have a car? In a neighborhood where over forty languages are spoken, it can feel impossible to get the news out to everyone who needs to hear it. When I got my ten cans, I hid them in the back of the car, knowing that having $250 worth of formula visible could result in having my window broken.

    At Santi’s next appointment, the pediatrician gave us the okay to transition to standard formula. I felt a rush of relief, believing that it would be easy to find from then on. But over the next weeks, I couldn’t find any WIC–approved formula on the shelves. We didn’t need it yet, so I decided to just keep looking and remained hopeful that the next time I checked, someone would have it. Once the shortage hit the news, I started to panic. Now I knew that it wasn’t just going to materialize. I tried to start pumping more, despite the pain it was causing me. I knew I couldn’t give him enough, but I had to try. I called the WIC Grocery Center again, dreading the response – surely this time they were out?

    Again they had plenty. Suddenly, I had an abundance. I had received freely and felt that I should give freely, so I decided to try to donate the preemie formula I still had, and offer a couple cans of the new kind to others who might need it immediately.

    Getting something so desperately needed directly into the right hands proved much more difficult than I thought. Facebook Marketplace doesn’t allow posting formula since it’s considered a medical product, and my posting in a local neighborhood group got plenty of likes but no takers. Coordinating a pick-up time with an interested person in a Chicago moms’ group proved too complicated. The group remains filled with posts like this:

    With the formula shortage going on I can’t find my babies formula NO WHERE. Does anybody have any extra cans of enfamil enspire (blue can)??? Willing to buy!!!

    Other moms quickly respond. But even when an offer matches the need, mutual aid isn’t seamless; the administrator recently posted to tell group members that they will be removed if they comment on too many free formula posts, and instructed people donating to write “Free” with a sharpie on the can to discourage reselling. She also suggested a new site, babyformulaexchange.com, where you can submit a form detailing what you have or need. I tried it, but I never heard back from them. In the end, I gave the preemie formula to a shelter for single mothers. It doesn’t feel as immediate, but I trust them.

    Maybe it’s for the best that I haven’t found anyone who needs his current formula. Recently, my nipples began to bleed. Trying to pump more has hurt me, but I still felt guilty. Was it okay for me to pump less since I still had the ability to produce more milk? If we can’t get enough formula, or someone else doesn’t get any because we did, is that on me? Am I obligated to suffer more than I already have? I know for sure that I shouldn’t have to ask these questions.

    This past month, we received free groceries through a program at the pediatrician’s office; my husband has finally found a good job after months of part-time gigs, and the social worker urged me to accept them while we waited for the first paycheck. There, the same week I found blood in my nursing bra, I found a cabbage in the box of produce. Cabbage is traditionally used to help a mother wean; its leaves are cooling and anti-inflammatory. I decided to take it as a sign that at least in the eyes of God, I am not obligated to push my body past its breaking point. Santiago – whose name means Saint James, advocate for the poor – will somehow be fed.

    Contributed By

    Rachel Cañon Naffziger is an artist, writer, musician, and keeper of a windowsill garden planted in formula cans. She lives with her husband and baby boy on the far north side of Chicago.

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