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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.

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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.

When I was expecting my first child, I wanted to know everything that could possibly be in store for his first year.

I quizzed my own mom and the friends who ventured into motherhood before I did. I absorbed parenting books and articles like a sponge. I signed up for classes on childbirth, breastfeeding and even baby-led weaning. My philosophy? The more I knew, the better.

Yet, despite my best efforts, I didn't know it all. Not by a long shot. Instead, my firstborn, my husband and I had to figure it out together—day by day, challenge by challenge, triumph by triumph.

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The funny thing is that although I wanted to know it all, the surprises—those moments that were unique to us—were what made that first year so beautiful.

Of course, my research provided a helpful outline as I graduated from never having changed a diaper to conquering the newborn haze, my return to work, the milestones and the challenges. But while I did need much of that tactical knowledge, I also learned the value of following my baby's lead and trusting my gut.

I realized the importance of advice from fellow mamas, too. I vividly remember a conversation with a friend who had her first child shortly before I welcomed mine. My friend, who had already returned to work after maternity leave, encouraged me to be patient when introducing a bottle and to help my son get comfortable with taking that bottle from someone else.

Yes, from a logistical standpoint, that's great advice for any working mama. But I also took an incredibly important point from this conversation: This was less about the act of bottle-feeding itself, and more about what it represented for my peace of mind when I was away from my son.

This fellow mama encouraged me to honor my emotions and give myself permission to do what was best for my family—and that really set the tone for my whole approach to parenting. Because honestly, that was just the first of many big transitions during that first year, and each of them came with their own set of mixed emotions.

I felt proud and also strangely nostalgic as my baby seamlessly graduated to a sippy bottle.

I felt my baby's teething pain along with him and also felt confident that we could get through it with the right tools.

I felt relieved as my baby learned to self-soothe by finding his own pacifier and also sad to realize how quickly he was becoming his own person.



As I look back on everything now, some four years and two more kids later, I can't remember the exact day my son crawled, the project I tackled on my first day back at work, or even what his first word was. (It's written somewhere in a baby book!)

But I do remember how I felt with each milestone: the joy, the overwhelming love, the anxiety, the exhaustion and the sense of wonder. That truly was the greatest gift of the first year… and nothing could have prepared me for all those feelings.

This article was sponsored by Dr. Brown's. Thank you for supporting the brands that support Motherly and mamas.

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In just over three weeks, we will become parents. From then on, our hearts will live outside of our bodies. We will finally understand what everyone tells you about bringing a child into the world.

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Our bags are mostly packed, diaper bag ready, and birth plan in place. Now it's essentially a waiting game. We're finishing up our online childbirth classes which I must say are quite informational and sometimes entertaining. But in between the waiting and the classes, we've had to think about how we're going to handle life after baby's birth.

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I don't mean thinking and planning about the lack of sleep, feeding schedule, or just the overall changes a new baby is going to bring. I'm talking about how we're going to handle excited family members and friends who've waited just as long as we have to meet our child. That sentence sounds so bizarre, right? How we're going to handle family and friends? That sentence shouldn't even have to exist.

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