At least three pediatricians are speaking out about many hospitals’ ‘baby friendly’ initiatives, which place premium importance on exclusive breastfeeding and skin-to-skin contact, while neglecting other potentially unsafe practices.
A generation or two back, new mothers stayed in the hospital for a couple of weeks. That model of post-partum care had drawbacks; for one thing, it was mainly designed around a one-income family in which the homemaker prepared all the meals and did all of the housecleaning, and it was assumed that after two weeks, women were supposedly recovered and ready to take care of older children, cooking, etc.
However, a longer hospital stay did mean that new moms had adequate time to fully recuperate from labor and delivery, as well as to get support from nurses and other hospital staff about caring for infants. While enthusiasm for breastfeeding versus bottle-feeding has changed depending on the decade (1960s: formula reigned supreme; 1970s: nursing was the rage), at the very least, more time on the maternity ward meant more time getting advice.
Since the 1980s, getting mother and baby home quickly—next day for natural births, within two or three days for Cesarean sections—has become the American norm. The wisdom behind what seems like haste is to get patients out of the way of infection (sadly, we all know that hospitals are full of it).
“Friendly” doesn’t always mean friendly towards the mom
Enter the Baby-Friendly Hospital Initiative (BFHI), launched in 1991 by UNICEF and the World Health Initiative. It was endorsed in 2010 by the U.S. Department of Health and Human Services; since then, 17 percent of U.S. hospitals have become “baby-friendly,” and the number is growing.
On the surface, the BFHI sounds wonderful. It encourages co-sleeping, breastfeeding, and bans pacifiers. But scratch that surface just a tiny bit and you find a proposal that’s all about all-breastfeeding, all the time.
Most of the ten line items in the BFHI seem designed by the most zealous of La Leche League members. Anyone who’s nursed a baby successfully will tell you that it’s a wonderful experience. But what about the women who aren’t able to nurse successfully? And what about the mothers who found that supplementing with a little formula actually helped them stick with breastfeeding? Although breastfeeding adherents claim that there’s no reason any woman can’t nurse her baby, sometimes dehydration, exhaustion, emotional issues, and any number of other things can mean that mothers choose formula over the breast.
Is it best, or “friendly,” for a hospital to push its mother to do something she either can’t do or doesn’t want to do? As Elissa Strauss reports in Slate XX, a JAMA Pediatrics article says that the BFHI has other drawbacks in this vein. Pediatricians Joel L. Bass, Tina Gartley, and Ronald Kleinman write “Unfortunately, there is now emerging evidence that full compliance with the 10 steps of the initiative may inadvertently be promoting potentially hazardous practices and/or having counterproductive outcomes.”
Some baby-friendly initiatives are actually hazardous
While the BFHI promotes skin-to-skin contact and co-sleeping, the JAMA Pediatrics paper reports that in baby-friendly hospitals, there is a documented risk of Sudden Unexpected Postnatal Collapse (SUPC) during skin-to-skin contact/co-sleeping—not because these things are bad (they’re not; they’re terrific, for bonding and many other reasons)—but because in these hospitals, mother and child are often left unsupervised during these periods. When co-sleeping and/or rooming-in are pushed, even when a mother is exhausted, it’s more likely that she will not notice when something goes awry.
When will we learn that what’s good for a mother is good for her baby? When will we understand that an infant’s first three months, often humorously referred to as “the last trimester,” are, in fact, a time when mother and baby are still tied together in crucial ways? For the obstetrician, the main outcome is a healthy baby, yes. But for society, for other caregivers, shouldn’t the main outcome be a healthy family?
The concerns of the pediatricians who wrote the article about the BFHI’s shortcomings are ignored at our collective peril: “If government and accreditation agencies wish to encourage and support breastfeeding, their focus should shift from monitoring baby-friendly practices and breastfeeding exclusivity to monitoring breastfeeding initiation rates coupled with evidence of lactation support both during and after the hospital stay. More attention should also be placed on ensuring compliance with established safe sleep programs, emphasizing the need to integrate safe sleep practices with breastfeeding.”
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