We appreciate the responses to our commentary by Burger, Labbok et al, Feldman-Winter et al, and Perrine et al.
We have several areas of agreement with the writers:
Although we agree with the writers that the new Joint Commission quality measure might improve breastfeeding rates at hospitals in which formula supplementation is routine, we are concerned that the proposed quality measure could negatively affect breastfeeding and mother and infant well-being at the many US hospitals in which formula supplementation is already used judiciously. For example, at the hospital in which we practice, 89% of mothers breastfed exclusively through discharge in 2009.12 Although we appreciate the value of exclusive breastfeeding, we believe that sometimes excessive enthusiasm for exclusive breastfeeding leads to counterproductive reluctance to give formula when it could be helpful. The proposed Joint Commission quality measure seems to fit this mindset and could do mothers, infants, and breastfeeding advocates...
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