When her newborn began losing weight because she was not producing enough milk, the hospital called in a lactation specialist. The aide was not covered by insurance and cost her $800.
A tube was attached to Hoffman's breast to stimulate milk production during nursing and she was required to "pump" in between baby feedings while her son slept.
"It was horrible," said Hoffman. "There was intense pressure to go the natural way and it wasn't working. It had a completely negative impact on the whole experience."
Like other new mothers, Hoffman had eagerly decided to breast-feed, but hadn't "given it a lot of thought in terms of how it would actually work."
"I suddenly went from this thing that was supposed to happen naturally to a complicated process," she said. "I did not have a moment when my body wasn't being used for something except for sleeping and pumping and sterilizing bottles."
Scientific evidence shows that breast-fed babies are less vulnerable to acute infectious diseases and allergies. Some studies also suggest that they are at lower risk for sudden infant death syndrome and serious chronic diseases later in life, including asthma, diabetes, leukemia and some forms of lymphoma, according to the American Academy of Pediatrics.
Research on premature babies has even found that those given breast milk scored higher on IQ tests than those who were bottle-fed.
At the University of California's San Diego Medical Center, the nursing staff is respectful of mothers who choose not to breast-feed for a variety of reasons, including a traumatizing pregnancy or plans for adoption.
But others, after hearing the benefits of nursing, change their minds, said Corey Anaka, a nurse and lactation specialist.
"We have a reasonable approach," said Anaka. "The whole essence is to teach mothers and to give correct information so they can make a conscious choice."
The hospital was just designated one of only 56 "baby-friendly" hospitals in the United States by the WHO. It has refused all free formula since 1997 — only for its gift bags, but hospitalwide. This and other pro-lactation policies have seen the breast-feeding rates at discharge reach 90 percent.
"The staff is awesome," said Cheri Wolf, who delivered a healthy boy by Caesarean section July 26 and began breast-feeding two hours later. "I even get the impression that if I ask the janitor a question about lactation he'd be able to tell me."
The 38-year-old single mother had hoped to breast-feed but was nervous that she, like other friends, would not be successful. But, an education program through the Red Cross that provides food vouchers to low-income women and a class sponsored by the hospital persuaded her to give it a try.
The state's Women, Infant and Children program also provides another incentive if women continue breast-feeding — it provides increased food allowances.
"We in the world of lactation consider human milk to be medicine," said Anaka. "Formula is like a foreign protein. This is a new baby, not a cow."
But critics say withholding formula puts low-income women at a disadvantage.
Jennifer Shu, an Atlanta pediatrician and author of "Heading Home With Your Newborn," said most babies will eventually get formula by the end of their first year.
Offering free samples can help families save money or just use certain formulas on a trial basis until they find a "good fit" for their baby.