Many new moms leave the maternity ward holding two things: their babies and free samples of formula, often packed into diaper bags and handed to them as they leave.
But new research suggests that practice might be on its way out.
A study published Monday in the journal Pediatrics found that the number of hospitals that don't distribute the free samples doubled in the last three years. In 2010, the last year studies, over a quarter of all hospitals didn't give out formula.
"We found a trend, in what I consider to be the right direction, that more hospitals are discontinuing sample pack distribution," said Anne Merewood, PhD, director of research for the Breastfeeding Center at Boston Medical Center and one of the report's authors.
She explained that multiple studies have shown formula freebies decrease both breastfeeding exclusivity and duration. Public health groups, including the Centers for Disease Control, say formula samples can negatively affect breastfeeding, particularly among first-time moms and those who are ill in the postpartum period.
To better assess the national picture, the researchers contacted more than 1,300 hospitals across 20 states. They found a great range in distribution practices.
"You need a catalyst in a state," Merewood said, citing California-based Kaiser Permanente's decision to stop distributing in many of its hospitals and New York City's move to end formula distribution at 11 city hospitals in 2007.
"Once hospitals look around and see others are not doing this, they stop, too," Merewood added.
The study also notes a broader pushback by the medical community at large against the distribution of free samples, which many argue results in conflicts of interest. There have also been more targeted efforts, including the "Ban the Bags" campaign, which says it aims to stop "aggressive formula company marketing tactics in hospitals" as they "undermine mothers who chose to breastfeed."
Susan E. Burger, PhD, president of the New York Lactation Consultant Association, said the samples can be a hassle for hospitals, which have to expend man hours stocking shelves. But she said "the most obvious and well-documented problem here is that there is clear evidence that the promotional samples reduce the doses of breast milk that infants receive."
However, not everyone thinks that giving up the samples is a good thing.
In a 2007 New York Times editorial, mother Jennifer Zajfe decried New York City's decision to cease distribution in some hospitals, saying she had a complicated delivery -- 20 hours of labor followed by an emergency Caesarean section -- that limited her milk production. "The formula samples were a godsend," she wrote.
Dr. Shieva Ghofrany, an OBGYN with Stamford Hospital, said that she too has seen cases where the formula helped new moms through a tough first night.
"Some women don't realize how hard breastfeeding can be," she said. "So they go home with nothing and then they have a situation at 4 in the morning where they're scrambling, and the husband is wondering what to buy. If the patient doesn't have a couple of samples to get them through to the next morning, it can make them much more anxious."
Ghofrany does not believe the free samples greatly influence most women; those who are devoted to breastfeeding simply don't take or use them. For those using formula, the samples can help eliminate some initial confusion in terms of what their baby likes and what they might want to buy, which Ghofrany explained is often done via process of elimination. Both she and Merewood agreed that hospitals do not give out enough to make a long-term difference for women planning to use formula, cost-wise.
But as the authors of the new study point out, if the tide is in fact turning against the distribution of free formula samples, it is doing so slowly: The majority of hospitals still give the packs out.
"We like to give things to people," Merewood said. "But the bottom line of my position is that it's a marketing technique, and marketing does not have any place in hospitals."