Mixed message on breast-feeding?

Lebron Powell doesn't dispute the benefits and chose to breast-feed her children, aged 9 months and 4 years old. But she says those who choose to use formula shouldn't be demonized.

"Breast-feeding is free. It's good for the baby and it's good for the mom. But it's hard and if you work and the employer doesn't support your pumping needs, you are in trouble," she said.

Hospitals have been offering formula freebies for decades, but they have a new incentive to abandon the practice.

The Joint Commission hospital accrediting group last year added "exclusive breast milk feeding" during newborns' hospital stays as a measure that hospitals can be evaluated on. While formula giveaways won't be evaluated, the commission mentions monitoring that practice when it educates hospitals on how to improve their performance, said Celeste Milton, an associate project director at the commission.

The goal is to discourage hospitals from giving infants formula when it's not medically necessary, said commission spokeswoman Elizabeth Zhani.

Central DuPage Hospital in Winfield, Ill., the suburban Chicago hospital where Ewald had her baby last March, boasts that 93 percent of its new mothers are breast-feeding when they're sent home. It also supplies lactation consultants to new moms — a service Ewald said she appreciated. But Ewald said she got a mixed message about breast-feeding, because nurses there wanted to give her baby formula to help him gain weight, and because of those free samples in her goody bag.

Hospital spokeswoman Amy Jo Steinbruecker said the gift bags contain "literature and samples of common items newborns may need, including a small sample of formula," and are meant to support healthy parenting and baby care.

But she said the hospital is examining the formula freebies as it seeks to be designated "baby-friendly."

The World Health Organization and the United Nations Children's Fund established that designation to encourage breast-feeding, with 10 criteria hospitals must meet. These include allowing new moms and infants to remain together throughout the hospital stay and not giving newborns any pacifiers or formula.

Jennifer Smoter, a spokeswoman for Abbott Nutrition, makers of Similac formula, declined to disclose how many hospitals Abbott provides with formula samples and would not comment on the practice. Representatives of Mead Johnson, makers of Enfamil formula, did not respond to several email and telephone requests for comment.

Haley Stevens, a scientific affairs specialist for the International Formula Council trade group, said not offering new moms formula samples "is really irresponsible."

New moms should have formula available, along with information on how to use it so they don't water it down or make other mistakes that could endanger their babies' health, Stevens said.

"We agree breast-feeding is the best, when you can do it," she said. "There's no question. But if one size doesn't fit all, it's good to have a backup."