The complicated problem with ‘baby-friendly’ hospitals

There was a time when giving birth in a hospital meant little chance for skin-to-skin contact and breastfeeding. Decades ago, babies were whisked away to nurseries and given formula (and moms were often given samples of formula to take home). If you wanted to breastfeed your baby, these hospital policies and routines could make it difficult.

That’s why in the early 1990s the World Health Organization (WHO) and the United Nations Children’s Fund began championing the Baby-Friendly Hospital Initiative (BFHI), “a global effort to implement practices that protect, promote and support breastfeeding.” In recent years more and more hospitals in the United States have adopted the principles of BFHI in order to increase breastfeeding rates.

The goal was laudable, but 30 years in, new research published in The Journal of Pediatrics suggests BFHI isn’t having a positive impact on breastfeeding rates, and some argue it is having a negative impact on new moms. Specifically, “Statewide breastfeeding initiation rates were positively associated with targeted breastfeeding outcomes. Similar associations were not found for Baby-Friendly hospital designation penetrance.”

A core tenant of BFHI is “rooming in”—babies and mothers are supposed to be kept together 24 hours a day. In theory, this is supposed to increase breastfeeding rates and bonding, but some moms and doctors say leaving infants solely in the care of exhausted people can be dangerous. Mothers can end up falling asleep while caring for the baby.

Dr. Colleen Hughes Driscoll of the University of Maryland School of Medicine in Baltimore was the lead author of a study published earlier this year that examined the number of infant falls at a hospital that was implementing practices to encourage breastfeeding in order to receive the baby-friendly designation.

“We found that as we improved our ability to support mothers with successful breastfeeding there was a surge in newborn falls,” Driscoll told Reuters. “This suggests that we may be adding to the burden of maternal fatigue, and increasing the risk of newborn falls.”

According to Driscoll, the old school practice of taking babies to the nursery were a barrier to successful breastfeeding, but also provided time for mothers to rest and recover. And it isn’t just exhaustion, but also the intense pressure to breastfeed that has some advocates worried that baby-friendly hospitals aren’t very mother-friendly.

Sarah Christopherson is the Policy Advocacy Director for the National Women’s Health Network and had her own experience with BFHI. A mom multiple times over, Christopherson had previous experience with birth and infant feeding by the time she had a C-section in a baby-friendly hospital. With her previous babies she’d successfully supplemented her breastmilk with formula in the hospital, but this time, when she asked for a bottle she was met with criticism from hospital staff, she writes.

“The nurse was stern and disapproving,” Christopherson writes, noting that the nurse implied that giving formula would be “giv[ing] up” on breastfeeding and that she would have to sign a waiver “acknowledging all of the risks associated with my terrible choice.”

She continues: “‘Reasons for supplementation’ listed on the form include “‘mothers who are critically ill,’ have ‘intolerable pain during feeding unrelieved by interventions,’ or have ‘breast pathology.’ For mothers who simply choose to supplement, the form makes clear: ‘The American Academy of Pediatrics says that routine supplements of formula for breastfed newborns should not be used.'”

Christopherson says the form made her doubt herself, and she tried to exclusively breastfeed. In the end, her daughter ended up dehydrated and jaundiced and was fed the formula that her mother had wanted in the first place.

Christopherson and others suggest that the problem with BFHI is that it is removing mothers’ needs and voices from the equation.

The new research published in The Journal of Pediatrics suggests BFHI isn’t having a positive impact on breastfeeding rates, but Baby-Friendly USA, Inc. (BFUSA) disputes the research. BFUSA, the “accrediting body and national authority for the BFHI in the United States…responsible for coordinating and conducting all activities necessary to confer the prestigious Baby-Friendly® designation and to ensure the widespread adoption of the BFHI in the United States,” says the research was flawed and came to “damaging conclusions from incomplete data.”

Critics of BFHI and BFUSA disagree on methodology but agree that mothers should be respected and have the information they need when making their own decisions about infant feeding.

That is, after all, why BHFI came about. Perhaps it is time for hospitals to worry less about adhering to strict policies and more about listening to mothers.

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