'I always thought I would never be that person': Baby formula shortage presents challenges for WV mothers

The baby formula shortage affecting mothers not only in West Virginia but across the country has changed her outlook. Leaving the store empty-handed now means her 7-month-old daughter could go hungry.

Mothers like Wheeler, a first-time mom, are experiencing the effects of a shortage caused by supply-chain issues from the pandemic and the recent recall of numerous baby formula products by Abbott Nutrition. The leading baby formula brand in the United States, Abbott Nutrition accounts for 42% of the market. The company is also responsible for supplying families for the Special Supplemental Nutrition Program for Women, Infants and Children.

Wheeler’s husband, Kanawha County Commissioner Lance Wheeler, warned her about the looming shortage and brought home off-brand formulas against her wishes.

The next day, she traveled to six different stores in the Charleston area before coming across her usual brand, Enfamil, at Walgreens. She never had purchased formula from a drugstore before. Her usual online outlet, Amazon, was also out of stock.

“It’s one thing for me to go without toilet paper,” Wheeler said. “But, like, I can’t really figure out something else for my child to eat if there’s no formula.”

After her small win at Walgreens, Wheeler reached out to her pediatrician to learn about alternatives. Together, they were able to formulate a plan to cushion her supply of her preferred brand.

Wheeler said her daughter goes through about one $44 container per week, averaging 32 to 40 ounces daily. Wheeler estimates she’s spent nearly $1,000 over the past week stockpiling enough formula to hopefully make it through the shortage.

“It’s one thing when it’s you, but when you bring this baby into the world that has no control over any situation, like, you’re going to do everything you can to make sure you meet their needs,” Wheeler said.

Infants can be sensitive to different types of formula, and Wheeler said she has been fortunate to find one that works well for her child. With help from friends and family across the country, she hasn’t had to resort to unfamiliar brands.

“We were fortunate, but, you know, that’s not everybody’s story,” she said.

Candice Pauley said she was unable to find her trusted formula brand before the birth of her second child three weeks ago. She had hoped to start her daughter on the same formula that had worked for her 2-year-old son.

Some nights during her pregnancy, she said her husband would check for formula online at a local Kroger about midnight only to find supplies exhausted when they tried to complete their order minutes later.

In one instance, Pauley said she and her husband drove to Teays Valley from Charleston in the middle of the night because their preferred formula appeared to be in stock. Once they arrived, they were met with empty shelves.

Despite the shortage, Pauley said she’s managed to keep an emergency stock in case something ever happened to her.

“That’s like literally how your mind’s thinking as a mom,” Pauley said. “Like, if something happens and I can’t give her milk right now ... how’s she going to eat?”

Pauley’s daughter lost weight in the hospital postpartum from exclusive breastfeeding, so she started her on a supplemental pre-made formula.

Pre-made, or liquid, formulas have been easier to find during the shortage because they have been free from recalls. But it’s not always cost effective when used as a supplement for breastfeeding because it expires 48 hours after opening.

Pauley said she only uses 6 ounces to 8 ounces of a 32-ounce can of formula in a 48-hour period.

“I would prefer to use powder, but we can’t find any powder,” Pauley said, noting she had never used pre-made formula prior to the shortage.

n n n

With powdered formula in short-supply, many mothers — including Wheeler and Pauley — have felt pressured to breastfeed their children. Wheeler says that’s not a viable option for every woman.

“It is not for the weakhearted,” she said. “It is a full-time job.”

Wheeler initially breastfed her daughter immediately postpartum, but was unable to produce enough milk to properly nourish her. During her one-month check-in with her pediatrician, Wheeler was told her daughter hadn’t gained enough weight.

“I felt like an absolute failure, you know, as her mother, because I feel like I’ve put everything into trying to nurse her and she’s still not getting enough from me,” Wheeler said.

After that, Wheeler said she began formula-feeding her daughter. She also said it would have been too difficult to continue breastfeeding after her maternity leave because it often required sleepless nights of pumping every two-to-three hours.

“I was really upset about it and felt pretty crappy,” Wheeler said. “And then, you know, people just give you so much grief if you don’t breastfeed.”

Wheeler noted feeling especially guilty about not being able to breastfeed during the shortage.

“It is just different, you know, like not something that you ever think would happen,” Wheeler said. “And then mom-guilt, like, you know, I nursed her. I should have done it longer, been more committed or pumped more. You know, stuck with it, so that then maybe I wouldn’t be as panicked as I had been about it.”

She is also concerned for her friends who are currently pregnant, including one who is a breast cancer survivor and is struggling to predict which formula will work best for her infant because breastfeeding is not an option.

Pauley recounted sleepless nights, anxiety and a lack of appetite as she breastfed her first child. After the first 10 days, Pauley said she lost around 30 pounds and was eventually hospitalized for postpartum psychosis.

“With being a first-time mom when the pandemic hit, I was so nervous just about everything,” Pauley said.

Now with her second child, Pauley is healthy and breastfeeding her daughter, attributing her success to less stressful conditions and a better understanding of breastfeeding. A combination of formula and breastfeeding has worked best, she said.

Despite the success, Pauley said she still feels the pressure to continue breastfeeding during the shortage.

“If I hadn’t decided to already breastfeed, I probably would’ve had to anyway,” Pauley said, adding she feels grateful for the support she has received from her family during this time.

Heather ONeal, an advanced practice registered nurse, certified nurse midwife, international board-certified lactation consultant and the founder of Breastfeeding for Busy Moms, says breastfeeding has many benefits, but can also present its own challenges.

Since the shortage began, ONeal said she has seen an increase in postpartum anxiety, depression and other mental health issues associated with breastfeeding within her clientele.

“It’s hard to reconcile the fact that there are certain expectations put on you to feed your baby a certain way, and then you don’t get the support you need and then you’re unable to feed your baby,” said ONeal. “And then there’s a lot of self-blame unnecessarily because it’s a system problem.”

Since many mothers return to work and have less time to dedicate to pumping, ONeal said it is difficult for mothers to exclusively breastfeed their children, even as alternatives are in short supply.

“Time is an invaluable resource for human beings,” said ONeal. “And I think that this formula shortage has really highlighted the fact that breastfeeding is work, that melting your body and turning it into food for another human being is work.”

n n n

Dr. Lisa Costello is the immediate past president of the American Academy of Pediatricians West Virginia Chapter and tends to patients at WVU Medicine Children’s Hospital as a pediatric hospitalist.

She said it can be difficult to give blanket advice for all those affected by the formula shortage.

“I think it’s hard to say there’s like a one-size-fits-all [answer], because every person is somewhat different,” said Costello.

One constant piece of advice she has is for mothers to avoid making their own or diluting store-bought formula. She said finding an alternative is safer.

The American Academy of Pediatrics says diluting formula can thin concentrations of essential proteins and minerals, potentially leading to electrolyte disorders and hospitalization. At-home formulas are also dangerous, Costello said, citing that though some claim to have done it in the past, we have now learned that it isn’t a safe alternative.

“Even if in the past that’s something that people have done, we have learned over time that that’s not a safe alternative and that really, you know, I recommend not doing the home formulas,” Costello said.

She also recommends families direct any questions to their pediatrician or health care provider, or to credible online resources like those published by the American Academy of Pediatricians.

“Every baby is different and we understand that as pediatricians. So, if you have questions, it’s always recommended to talk to someone,” said Costello.

At WVU Medicine Children’s Hospital, she said pediatricians are being mindful of which brands will be easiest to access when matching patients to a formula. Off-brand formulas have served as a good alternative to out-of-stock name brands for basic milk- or soy-based formulas.

Costello is a mother herself and said she has experienced transitioning formulas with her child during the shortage.

“In my own personal experience, my baby was on the formula that got recalled back in February, and I made a transition to a different brand,” she said. “She did just fine with that transition. Again, I was also breastfeeding, but you know, I’m doing some supplementing as well.

“I do hope that we all can get to a place where we’re not shaming or making people feel guilty because that’s not helpful, particularly in a pandemic like where we’re in right now.”

The baby formula shortage follows the shutdown of Abbott’s facility in Sturgis, Michigan, on Feb. 17. The company issued a recall on several of its powdered baby formula products the same day.

The Food and Drug Administration and the Centers for Disease Control and Prevention launched investigations into the facility and the reported consumer cases that prompted the shutdown. Between Sept. 20, 2021, and Feb, 24, 2022, there were three reported cases of cronobacter sakazakii and one salmonella infection in infants who had consumed formulas manufactured at the alleged facility.

Two of the children died.

Though Abbott officials said there was no evidence to link the infections with their facility, the FDA found the cronobacter in five environmental samples from non-production areas in the plant during an inspection on Jan. 31, 2022. Product samples were free of the suspected bacteria, and no salmonella was found.

Cronobacter sakazakii is a “bacterium that can potentially cause severe foodborne illness primarily in infants” and can cause sepsis or meningitis, according to the FDA. The CDC says it can live in dry foods like powdered infant formula, powdered milk, herbal teas and starches.

The FDA has said that the alleged contaminations could be the result of unsanitary conditions, citing previous inspections at the plant that found presence of the bacteria in environmental samples. On May 17, the FDA issued a statement announcing an agreement between the feds and the company that paves the way for the facility to reopen in the coming weeks.

As the demand for formula has increased, other name brands have stepped up production to help fill the void. Additionally, the FDA announced on May 16 it would approve the distribution or importation to the U.S. of some infant formula products that were originally manufactured in the U.S. but intended for foreign markets.

In the meantime, some women have been also sharing breastmilk via Facebook groups. Costello recommends utilizing accredited breast milk donor banks to ensure the milk has gone through proper screening and is safe for consumption.

“We can’t know for sure whether breast milk from a friend or, you know, these online groups are safe,” Costello said. “And so that’s why it’s important to check with the milk donor banks.”

“We need to find a way to support one another,” she added. “I think that’s what we are as West Virginians. We try. We find ways to help one another. But in doing that helping, we need to make sure that we’re doing it in a safe way.”