One of the most difficult obstacles breastfeeding advocates face in the hospital involves the distribution of complimentary gift bags to new mothers supplied by infant formula companies. Although these items have been shown to hamper the establishment of successful breastfeeding, many nurses balk at the idea of refusing to hand them out. The reasons vary from nurse to nurse but seem to center around the desire by nurses to be viewed in a positive light by patients and their families. It is perceived that being able to give a gift will help with this process. Rarely does anyone stop and think about the fact that this is exactly the conclusion formula companies want hospital personnel to arrive at in their thought processes on this issue. Many are surprised when they learn that these items are not in fact "free."

In seeking to overcome this hurdle and be supportive of the breastfeeding dyad, the nursery nurses at our hospital sought to try and reduce the number of gift bags being sent home. The nursing personnel on our unit were informed that we wanted to do an informal trial and asked for everyone's cooperation. We asked that the practice of automatically handing or offering a gift bag to every mom be stopped. If a mom asked for one or presented a coupon, we would give it to her but it was not to be a routine part of the discharge process. The staff agreed to assist with this.

With an 85-90% in-hospital breastfeeding rate, we noted some immediate changes. Where we once gave out 25-30 gift bags per week, we noted that number dropped to 5-7. None of the negative consequences followed that has previously been predicted by some of the staff. We received no calls from parents who were irate at being slighted or who had babies who were starving having been deprived of their free formula. Our normally high patient satisfaction marks remained stable. A few moms returned the next week to say they forgot their free bag but we felt by this time they were further down the road to successful breastfeeding and less likely to suffer negative consequences.