Article: Baby-Friendly Hospitals Can, Paradoxically, Be Unsafe for Newborns

leslieknope

I came across this and thought that it was interesting and pertinent to our shared interests (having babies), so I wanted to share. 

https://www.slate.com/blogs/xx_factor/2016/08/23/baby_friendly_hospital_initiative_criticized_as_unsafe_in_new_jama_paper.html

I am not trying to police anything, but please read the article if you feel compelled to comment. JAMA is a pretty credible source, and I wouldn't share an article like this if it weren't. 

catem07

Thanks. I'm a FTM so I don't have experience with this, but it's something that's really interesting to me. My mom didn't produce enough milk with me but she kept trying and I ended up underweight at one point. She broke down crying at the doctors office when she finally realized it. 

I also read an article about the rooming in issue. I guess it was a big deal around here lately. I really feel for STM+ who just need a night or two of sleep and their partners can't be with the baby because they have to be home with the other kid(s). 

I know my hospital doesn't give our pacifiers but you can bring your own. 

schef070911

Thanks for posting this! This is definitely an aspect of childbirth as a FTM that I need to learn more about.  I didn't even know that "baby-friendly hospitals" existed (I guess I assumed they're all "baby-friendly" before??) and it's interesting to see the medical response to some of their assertions.  Curious to see what others have to say!

leslieknope

@schef070911 here is a hint: all hospitals are pro-baby, and are friendly towards babies. The BFHI is an initiative that started with very good intentions, but some feel that, like with many other things, the pendulum has swung too far in the wrong direction. 

This is all stuff that each person individually needs to think about and talk with their doctor about. Ask questions, and stand up for yourself. 

schef070911

@leslieknope That makes much more sense! 

Rileypie

I have heard of these hospitals and so thankful I didn't deliver my first babt in one. We used a pacifier from the beginning and we had no breastfeeding issues. Later on, at 6 months my supply dropped despite all my efforts and we ended supplementing with formula because feeding my baby and keeping her healthy was more important that being obsessed with breast milk only. We also sent our baby to the nursery for a few hours to get some sleep. I was paranoid and couldn't sleep with her in the room, was afraid soemthing would happen. And guess what we all survived. She is a happy and healthy 2 yr old despite all the 'wrong' things we did. I think you have to do what you feel is right for you and your family. Women shouldn't be pressured to care for their baby any certain way, as long as the baby is healthy and happy who cares. 

elplocho

"Other concerns in the JAMA paper include the encouragement for rooming-in, even when the mother is exhausted or sedated. They believe this can lead to unsafe conditions for the newborn, and that parents,"

When I had my second I was fine but exhausted. I got sick and only then they would take my baby so I could rest. The nurse still gave me a hard time.
 A different nurse told me that during the night they had rescued dropped babies (more than one) during the night because moms were so tired. I do not understand the sense in rules like this. Personally I feel it's so hospitals need less nurses to take care of babies.

allybadry

The pressure to breastfeed was one of the primary contributing factors to me developing ppd. I produced plenty of milk and my little guy had a perfect latch- he was just lazy. I spent 3 weeks desperately trying to breastfeed a baby that was always hungry. Plus pumping so that I could give him breastmilk via bottle when "from the tap" didn't work. I spent 1.5 of every 2 hours feeding, pumping or cleaning my pump. I eventually gave up and just ep for 4.5 months before we were able to try at the breast again. I pretty much didn't leave my house that whole time for fear of being away from my pump too long, it was awful.

I certainly understand the motivation behind these hospitals but we need to remember that healthy babies neef healthy moms morethan breastmilk.

Dannylion24

I've delivered 4 babes in 3 different hospitals and they've all had a nursery. Whether or not I used it really depended on the difficulty of the delivery itself and the temperament of my newborn; also how long I stayed (I've checked out early to get back to my family). Even if I didn't use the nursery, I was always grateful to know it was there if I needed it since my husband never stayed with me after my first (even when I had a child end up in the NICU). Personally I would not deliver in a hospital that did not allow me a choice. With my last there was some comment about not allowing pacifiers, but the nurse 'snuck' me one anyway - most likely because I was a 4th time mom at that point. Confidence and voicing your opinion goes a long way, so does kindness and common curtesy. It's easy to feel like it's all out of your control, but it doesn't necessarily have to be. Do your research and explore your options. Good article. "The more you know ... "

elplocho

allybadry said:

I certainly understand the motivation behind these hospitals but we need to remember that healthy babies neef healthy moms morethan breastmilk.

Exactly

mamabear2015

I just feel the need to say that I gave birth at a baby friendly hospital and it was amazing. While breastfeeding, no pacifiers, and rooming in were the default that did NOT mean you were denied other things if that was something you needed. Treating any rules with Militant strictness is bad but I would much rather give birth at one of these hospitals than one that would potentially move my child or give him or her formula or a pacifier without my knowledge. Not that these things are bad but they sure as hell aren't the choice of the hospital to make. 

pinkshades05

I agree that hospitals need to set up an environment for safe sleeping practices but I won't be bashing hospitals for trying to be "Baby Friendly." As a STM, I know what to expect but for a FTM, having a baby for the first time can be a new and scary thing. Some hospitals push things on the parents that maybe they didn't want initially but they feel intimidated because this is the first time. I agree with @mamabear2015 that these policies shouldn't be black and white rules, but looking at what's best for the family overall. 

leslieknope

elplocho said:

 A different nurse told me that during the night they had rescued dropped babies (more than one) during the night because moms were so tired. I do not understand the sense in rules like this. Personally I feel it's so hospitals need less nurses to take care of babies.

This is a very big concern.

pinkshades05 said:

I agree that hospitals need to set up an environment for safe sleeping practices but I won't be bashing hospitals for trying to be "Baby Friendly." As a STM, I know what to expect but for a FTM, having a baby for the first time can be a new and scary thing. Some hospitals push things on the parents that maybe they didn't want initially but they feel intimidated because this is the first time. I agree with @mamabear2015 that these policies shouldn't be black and white rules, but looking at what's best for the family overall. 

Yes, like breastfeeding. 

I realize that I am projecting. But when you give birth in an environment that treats formula like poison, it is hard to be confident in pushing for that, even if it's an informed decision that you have made. 

ETA: as a STM, I don't anticipate this being an issue for me. You don't like my decisions, judgy nurse? 

mamabear2015

But @leslieknope, formula gets pushed on moms just as often.  Breastfeeding isn't the problem, nor is support of breastfeeding, its dick healthcare practitioners. Asa a breastfeeding mom I see nurses pushing formula JUST as often as breastfeeding.  

allybadry

@leslieknope @mamabear2015 I think that qhat we really need are nurses, doctors, hospitals, etc that are looking to offer care rather than protocol. I needed nurses that were willing to take the time to talk about options and ramifications and help me make my own decisions. 

I had never considered a reality in which I didn't breastfeed and for the most part I am happy I made it work. But I do wonder if those early months would have been better if I hadn't felt as much pressure as I did.

I remember sitting there a few hours after giving birth having had thw fourth stranger contort my boob into different shapes and shove it in baby's mouth only to have him pull off soon after. I was told he was too small, his sugars were too low, I needed to try harder because he was starving. I felt like a failure as a mother, I mean feeding your baby was the moat basic thing a mother does and I couldn't. Add to that the pain from a third degree tear and a near hemorrhage and I was a mess.

What I needed was for someone to say a little formula won't hurt, we can try again after you've slept and eaten.

NESeattlite

I could not agree with this article more!! Thank you so much for posting.  I delivered my first with zero complications in a baby friendly hospital and I'm really debating whether to do so again.  No nursery option, just one LC visit, and a discharge barely 24 hours later when we were NOT mentally ready.  My mother was horrified and in hindsight I am too.  The birth was easy (relatively) but the subsequent 48 hours were not and more rest and support would have gone a long long way.  UO alert: I despise lactivists and the whole natural/attachment parenting movement and blame so much unnecessary stress and possible PPD on their "guidance" for baby first, at all costs to mom's sanity. <end rant>

gardenmama17

I wish I could read the JAMA article.  I may try to pull it at work tomorrow.  While JAMA is a wonderful source, it does look to be a perspectives paper, which may be expert opinion (vs. a clinical trial, which would have more weight IMO).

That being said, I did not have DS in a BFH.  I found many practices of our hospital to be similar, but not as "restrictive" as the article highlights as a weakness of BFHI.  For example, we were encouraged to have skin to skin as soon as possible (even for me in the OR--unfortunately my 10lb+ darling would not fit on my chest during the surgery, so he went in Dad's shirt), but we were supervised.  We were encouraged to breast feed, and had 24/7 lactation support.  I did EBF, but was supported in using formula (at the breast with a supplemental nursing system) until my milk came in.  The article hits the nail on the head about how stressful it is trying to feed a newborn for a few days when you CAN'T SEE ANYTHING COMING OUT OF YOUR BOOB.  There was no nursery, but my nurse took him for 2.5 hours each night so we could get a bit of rest.  I can definitely also see setting up patterns for bed sharing while exhausted with "rooming in".

Where's @scorpiomer?  (Yes, I am bat-signalling you! )

Aviatrix

The hospital where I gave birth to C was baby friendly. But they were also big on safe sleep practices. Like most things, it can be bad if taken to either extreme. 

ladameperdue

"UO alert: I despise lactivists and the whole natural/attachment parenting movement and blame so much unnecessary stress and possible PPD on their "guidance" for baby first, at all costs to mom's sanity. <end rant>" 
@NESeattliteYES. Perfectly put. I was thinking about posting this as my UO last week and then thought, 'too soon' ha. Hate all the self-identity and fearmongering and parent-bashing tied up in it all. 

asjas15

@leslieknope great thread! Thank you for starting it. We had DD at a BFH and I loved it but definitely struggled with some practises. I got that skin to skin is important but I was so sad when I saw how much DH wanted to hold her and she was over an hour old and he still didn't get to hold her.Everytime I asked the nurse can he hold her she was like after skin to skin. Eventually I just picked her up and said hear hun hold her, I got some glares but really was 2minutes going to make that much of a difference?Nope! Happy, crazy 14 month old running around my house

edited: its late my spelling sucks

mrsstuessy

@ladameperdue I don't really think saying you despise attachment parents helps stop parent bashing. I also hate parent bashing That is why I don't go around saying I despise someone for parenting a certain way. I realize I am slightly crunchy. But, honestly I don't care how you feed your kid, how you give birth. I just want you to be supported. So, let's seriously stop the parent bashing. 

Breesy14

This is a really thought provoking article.  I can see how those issues are very valid points.  I haven't read everyone's response yet, but wanted to share that I had a great experience at my baby friendly hospital.  I felt that the nurses never pushed me toward any decision, but rather listened to me and supported whatever I chose.  They gave me information that was objective and allowed me the opportunity to make informed decisions that worked best for our family.  I was very grateful to have their support in BFing though if I had chosen to FF, they would have been right there showing me how at the first feeding every step of the way.  Same with rooming in/out with baby.  Pacis were just a BYOP sort of thing.  (side note: I brought one, but didn't use it because I wanted to wait until my milk came in.  I started using it when he was 5 days old.  It never interfered with BFing and he gave it up on his own at 4 months.)  I remember them explaining these things during the hospital tour I took when I was pregnant. The hospital is proud of how they support women during this time in their lives.  They really try to take all factors (best for baby, best for mom, best for family, and best for safety) into consideration and realize that every situation is a bit different and requires a different care team.  At least that is what they say and what I experienced.  Anyway, I wanted to share because I think there may be more of a balance in many hospitals between safety and what the WHO pushes than what the article implies.  I'm sure this hospital isn't unique.

pinkshades05

@leslieknope I can understand that you've had a bad experience in the past. My mom is a lactation consultant and I know they aren't all equal in knowledge and experience. My mom is the first to say that formula was made for a reason, so babies wouldn't starve when breastfeeding wasn't going well.

I don't think it's the "pushing breastfeeding" that is the problem. We have a huge lack of professionals that can really tackle breastfeeding problems. If there is a problem with your liver, you get blood tests, ultrasounds, xrays, etc. There's none of that for breastfeeding unless you have a really good LC or nurse who knows the right questions to ask. Very few look for tongue ties or diagnose appropriately. Very few people ask WHY 1/3 of mothers underproduce. We just don't have the support to follow the push for breastfeeding. Does that mean everyone has to stop recommending it? No. But I do understand how moms were set up to fail and without my support with my second daughter I would have given up, too. It took 6 months for breastfeeding to finally work right and I completely understand why women quit.

But we have a broken system and I think instead of blaming the hospitals, we should be asking why we don't have better support after babies come home. 

leslieknope

I'm confused and I need to do more research. 

I mean, by nature hospitals are baby friendly. Yes? You're not going to find a hospital here in the states that is not. However, to be part of the BFHI, you must maintain certain standards, right? And if you don't, you are just a regular old hospital that is, of course, baby friendly. 

leslieknope

I guess, if it has a nursery, provides formula even when it's not medically necessary, and provides pacifiers, then it's basically just a hospital that delivers babies. 

Rileypie

@allybadry I'm sorry you had a rough time. I had bad PPD and PPA too. And a good deal was over feeding. 

allybadry

@pinkshades05 I think you have some perfectly valid points but in the same breath almost highlight one of the main issues. Correct me if I'm wrong, but I believe @leslieknope had said on a different thread that she has no intention of breastfeeding- which should be perfectly fine (her baby, her body, her choice and all that). But we continue to see formula as a back-up to breastfeeding rather than an alternative.

We always talk about best for baby, and I doubt there will be very few that would suggest breastmilk isn't the better of the two options if everything else is constant. But sometimes it just isn't what is best for mom, for whatever reason and we need to respect that as much as we respect moms who will ebf no matter the struggle.

pinkshades05

@allybadry I did read that and I do understand that some moms choose formula and why. I am simply disagreeing with the why the article says that hospitals promoting breastfeeding is bad. 

ladameperdue

@mrsstuessy I think she's saying what she despises is the valuation of the child's supposed needs over those of the parent, inherent in both lactivism and attachment parenting. I would agree with that. 

mrsstuessy

@ladameperdue So she despises a certain type of parenting. Yeah, that isn't really helping anything. If it isn't for you don't do it. You don't need to "despise" a certain type of parenting. I know of lots of parents who do attachment parenting. They like it. It works for them. They are happy and have not lost their sanity. They do no give a rats ass if you do it as well. So, if we are going to claim parent judging is bad let's not do it. Sorry, but you are being a hypocrite. 

leslieknope

Catching up, but I don't read @ladameperdue's comment as hating parents who practiced AP or EBF, but rather the movement behind it and the over-the-top push for everyone to adhere to those standards. It definitely marginalizes those of us who are not into that.

On the other hand, I am not @ladameperdue, so I could be off base. By my feelings are similar to what I stated above. I can love people who practice AP and encourage them at every turn whilst still disliking the movement behind it and how it isolates people who disagree.

mrsstuessy

I guess we will just have to disagree and that is ok. I do not think it is isolating. And like I said before pretty much all the AP parents I know do no push anyone to adhere to any standard. I know a LOT of AP just because of the circles I am in. Just curious, do you know a lot of AP families? 

mrsstuessy

As long as we can agree that I am allowed to love and support formula feeding parents, but not at all like the formula movement that took place to make it so popular in America. I honestly do love a lot of formula feeders. But, I don't like the movement. Is that ok for me to think?

edit: That comment was for @leslieknope

leslieknope

Um yes? I mean, are you talking about the movement from the 80's? Or are you saying that there is currently a movement by formula feeders to pressure moms into not breastfeeding? Because, I mean, on the Enfamil site it even says that formula is a good alternative to breast milk, so it's not like they are ramming anything down anyone's throat. 

Like, I literally just googled for probably 5 minutes (productive day...) and couldn't find any articles anywhere that indicate that formula is better than breast milk. So where is this movement, shaming mothers for providing their kids with breast milk? 

@mrsstuessy

ArchyFlores

@leslieknope the only shaming I can find about breast feeding mothers comes from those people who shame them for feeding in public. I'm reaching...I know.

mrsstuessy

@leslieknope Yes, I mean the movement that took place starting, honestly, as far back as the late 1960s and through the 1990s. I could really go on about how horrible, racist, etc the whole movement was. But, I am totally ok with people formula feeding now, as long as they are aware of their options. I can totally hate that movement and you can totally hate all the AP stuff. And we can start our special GG thread in November. Deal? 

NurseLaLa

This article seems to highlight a lack of proper nursing care rather than the initiative, itself. Skin to skin is amazing and great! Having baby close helps regulate their vitals while providing closeness which can encourage breastfeeding and bonding. 

ladameperdue

@mrsstuessy yes, this is exactly what I would say, too - hating the movement (especially its origins and when taken in its purest form) without any judgement on those who follow it. Everyone has their reasons! 

clickclackmoo

Need to read the article. Just found out the hospital where I will deliver has no nursery. The hospital where I delivered my son seemed to practice "baby friendly" lite. I sent my kid to the nursery every chance I got at night because I had a 4-day induction and barely slept or ate anything but jello during that time. They also had a lactation consultant who may as well have been an angel from heaven and told me my baby wasn't trying to kill me by nursing 24/7, he was just really smart and trying to get my milk to come. She also gave us a pacifier. I will love this woman forever. (The other lactation consultants were pretty meh, though.)  My husband and I both did skin to skin every chance we could, and it was really nice. All that said, I can see how taking "baby friendly" (god I hate that term) too far could have really negative consequences. I honestly felt like in general I stopped mattering as much once the baby was born. And that was a pretty rough transition after going through childbirth and learning to feed someone with a very sensitive part of my body. And if I didn't have those three-hour breaks with the baby in the nursery, our first few days at home would have SUCKED.

As for the sub-debate, I've got no love for "lactivists." I've seen too many of my brilliant, well-educated friends shamed for not being able to nurse. I'm pretty "you do you, bro" when it comes to parenting, as long as it's not hurting the child. But pushing breastfeeding to extremes disregards the mama, and sometimes even the baby. And I can't get behind that.

{sorry for the wall o text}

Beckyf321

I'm a dietitian and when I was completing my undergrad we had to learn about the baby friendly initiative in my Medical Nutrition Therapy class.  Personally, I'm a fan of it because of the benefits it does provide, but as with most things, it doesn't work 100% for everyone.  I breastfed both my kids and they both took a pacifier.  We couldn't do skin-to-skin as soon as they popped out because they both had minor issues at birth.  Also, like another poster stated, some of the issues stem from a lack of hospital staff training/knowledge and being understaffed.

I will always support, encourage, and help wherever possible for a mom to keep breastfeeding.  Too many don't understand how hard and painful it is at first.  I know the physical and monetary benefits from it.  That being said, if a mom/family chooses to formula feed, then I support that because it's what is right for that family and works for them.

Beckyf321

BTW, interesting bit of knowledge, did you know that if 90% of moms breastfed for the recommended amount of time it would save the US $150 billion dollars in medical costs?  That statistic blows my mind.