If you’ve given birth in the past two decades, you’re likely familiar with the Baby-Friendly Hospital Initiative. This program, launched by the World Health Organization (WHO) and the United Nations Children’s Fund in 1991, was created with the goal of increasing breastfeeding rates. The plan included nixing hospital formula samples, encouraging skin-to-skin and breastfeeding immediately post-birth and educating moms on the benefits of breast milk. But new research released by the American Academy of Pediatrics (AAP) has found that Baby-Friendly Hospital Initiatives don’t actually seem to be working.
The AAP reviewed data from the 2018 Centers for Disease Control (CDC) Breastfeeding Report Card to compare the impact of the Baby-Friendly designation versus breastfeeding rates in facilities that don’t adhere to Baby-Friendly guidelines. According to their report, Baby-Friendly hospitals “did not demonstrate a significant association with any post-discharge breastfeeding outcome,” and “there was no association between Baby-Friendly designation and breastfeeding initiation rates.” In other words, moms who give birth at Baby-Friendly hospitals are not initiating breastfeeding more frequently or breastfeeding longer than moms who give birth elsewhere.
Even more troubling, the report notes that in recent years, the Baby-Friendly designation has been linked with an uptick in newborn falls from exhausted moms accidentally dropping their babies. They also note the growing “adverse perception” of Baby-Friendly facilities, based on moms’ bad experiences.
The problem is that “Baby-Friendly” guidelines can often be carried out in a way that isn’t actually mom-friendly. Baby-Friendly hospitals don’t have nurseries, or they have very limited nursery areas that they discourage moms from using because the goal is to keep moms and babies together at all times. That means moms are often denied sleep and recovery time, and they’re asked to perform all infant care themselves, even though they’ve just given birth.
I gave birth to my son in a Baby-Friendly hospital in 2014, and I was even expected to administer his first bath myself. We were given a “quiet hour” immediately post-birth, during which he was forced onto my breast over and over again by overzealous nurses. Then I was taken to a recovery room, delirious from a 22-hour labor and bleeding through my hospital-issued mesh underwear, where another nurse expected me to be able to stand up and wash a slippery, soaking wet newborn in a tub. Throughout the rest of our hospital stay, a nurse came in every two hours to put the baby to my breast or coach me on the benefits of breastfeeding. I didn’t sleep for more than an hour at a time for my entire recovery.
The emphasis on breastfeeding at Baby-Friendly hospitals can be extreme, which can leave moms feeling a lot of stress and guilt. These hospitals don’t offer pacifiers, formula or bottles, and as a part of their compliance with the Baby-Friendly Initiative, hospital staff are instructed to “counsel mothers on the use and risks of feeding bottles, teats and pacifiers.” Kristen Hall, a mom of one from Dallas, said the pressure to breastfeed after giving birth to her premature daughter in a Baby-Friendly hospital was so overwhelming it left her in tears.
“I had a good experience with the hospital,” she tells Care.com. “But when I was in the NICU, I thought the breastfeeding nurses were judgy and stressful, and they made me feel terrible. My milk never came in, and they pushed and pushed. They even made me tape some tube thing to me. I finally broke down and told them I couldn’t take it anymore.”
Even pediatricians have spoken out about the “unintended consequences” of the Baby-Friendly Initiative. In a 2016 review in JAMA Pediatrics, pediatricians Joel L. Bass, Tina Gartley and Ronald Kleinman wrote that, “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.”
In their piece, they mention the risk of suffocation when moms are left unattended during skin-to-skin time and the risk for falls from unsafe sleep practices when moms are expected to room in with their newborns. They also note that formula supplementation can support breastfeeding by helping to take the stress off of moms who are waiting for the milk to come in and that pacifiers have been shown to reduce the risk of SIDs.
Not every Baby-Friendly hospital ends up being a bad experience for moms. Sarah Petrick, a mom of two from Taylor, Michigan, tells Care.com that nurses at her hospital kept bassinets by the nursing stations, so moms could get some sleep. And Sarah Crane, a mom of one from Dallas, says she felt completely supported when she gave birth in a Baby-Friendly facility last year.
“The rooms were mother-baby, and the lactation consultants saw me several times,” she tells Care.com. “I had lots of help, and if I had a question, they were wonderful.”
While some hospitals certainly do it better than others, the inconsistency in the Baby-Friendly experience, combined with the fact that this initiative isn’t even succeeding in its goal of getting more women to breastfeed, seems to indicate it’s time to go back to the drawing board. As of March 2018, there are 500 hospitals in the U.S. with a Baby-Friendly designation, but the AAP advises in their new report that “the current emphasis on universal Baby-Friendly designation should be re-evaluated.” Being Baby-Friendly is great, but it has to start with taking care of moms. Whether they’re breastfeeding or formula feeding, moms are patients at the hospital, too, and they need to be healthy, rested and nurtured to be able to give their babies their best.
