“The sight and sound of babies crying out for food and fluids are why I decided to speak out. Babies are denied food and fluids to promote exclusive breastfeeding.”

As a mother-baby nurse, I’ve seen many preventable episodes of emotional distress for families in my thirty-year career. Unfortunately, The emotional distress increased significantly when the Baby-Friendly Hospital Initiative was implemented at my hospital. Some episodes of emotional distress are unforgettable, so I felt compelled to speak out about them, hoping to bring about the much-needed change to protect newborns from hunger and maternal mental health.

Mothers are incredibly vulnerable after giving birth, as their bodies transition physically and hormonally. They have a new life to take care of while recovering from birth and require compassionate, respectful, and individualized care. However, the Baby-Friendly breastfeeding protocol is one-size-fits-all and does not allow individualized care. Mothers must follow the BFHI protocol regardless of how they feed their baby or how complicated their birth was. We know as health care professionals that no protocol can be safe and effective without individualized care.

 Evidence based medicine cannot replace clinical judgment or account sufficiently for the complexity of individual cases. The limitations of EBM must be acknowledged and addressed so that it can be used effectively and without compromising patient care. -Mark R. Tonelli, MD, MA

Parents Are Taught Infant Formula Is Dangerous

I remember caring for a fresh c-section mother who had delivered 37-week healthy twins. Breastfeeding and latching seemed to be going well, but both babies lost almost a pound by the end of day two. These babies were in great danger of complications from insufficient feeding and required supplementation. The mother was so distraught at the thought of feeding her babies infant formula that she sobbed with every feeding. In her mind, she was feeding her babies poison instead of the life-saving nutrition that would keep them healthy until her milk came in to breastfeed them sufficiently. She told me they were taught in their baby-friendly breastfeeding course that infant formula was harmful and would cause multiple diseases such as cancer, obesity, and low IQ, which is false or grossly exaggerated.

The demonization of infant formula that she was taught and read about during pregnancy became part of her beliefs that she couldn’t shake, even after being re-educated. The father of the babies then confided in me that they both swore on a Bible that the babies would not get any formula no matter the reason. 

 

Bonding Misinformation

Parents who decided or needed to bottle feed were highly concerned about not bonding with their baby because they were taught breastfeeding promotes a special bond. In both situations, the parents suffered great anxiety, emotional distress, and inadequacy as new parents. In some cases, this strained the relationship with their partners. Research has confirmed that a baby doesn’t bond with breastfeeding or formula feeding—a baby bonds and thrives on being fed with love by present and loving parents.

 

 

The misinformation about the Second-night syndrome, cluster feeding, and HUNGER

 As a nurse and a mother, my instinct has been to respond to someone’s needs and try to alleviate discomfort for as long as I can recall. Parents are taught that constant frantic crying and cluster feeding all night long without satisfaction is normal newborn behavior. I’ve seen many new mothers go against their intuition and accept this even though it causes them much distress. “A baby crying out from hunger is so painful to hear.”

 

 

 I frequently and proudly advocated for babies under my care when I knew they were hungry. I discussed temporary supplementation with their parents to ensure these babies were comfortable and safe. But many nurses and physicians seem intimidated by lactation consultants and the policies they know can be detrimental to patient safety. A baby crying for hours even after being fed at the breast does not have their physiological needs met.

Basic human needs like hunger, thirst, and sadly, even the essential requirement to be comforted when in distress are ignored, and newborn hunger has been normalized. 

 

Sleep Deprivation and Profound Exhaustion

 An example of how the BFHI has caused many new parents emotional distress is a complete lack of understanding and compassion regarding extreme sleep deprivation. It’s not unusual to see new parents become joyless and angry, often with each other. Tears are a common occurrence. Family members who start out wanting to stay and help become exhausted themselves. Being a night shift nurse, I’ve seen many fathers leave during the night because the constant crying of a second-night breastfed baby who is awake all night becomes intolerable, and the mom is left exhausted and all on her own.

This is also the time when most newborn falls happen. Actually, in my unit, most of the falls were from our Dads falling asleep in a chair holding the fussy baby, trying to let mom rest. Again, completely preventable- just an ounce of formula will satisfy the baby’s hunger, and mom and dad can rest while the baby is asleep. This allows them to experience the pure joy of being a new parent. 

Breastfeeding Education is Not Based on Current Research

Baby-Friendly education for health care professionals has caused some new nurses to accept that a baby’s stomach can only hold 5-7 cc’s, that breastfeeding alone will bring up a baby’s low blood sugar, and that supplementation is unnecessary for a crying dehydrated baby under phototherapy lights. None of this is accurate, causing delayed treatment and sometimes adverse outcomes, which is unacceptable. 

 

The Emotional Toll On The Nurses 

 Those of us who have had a long career in maternal newborn nursing have seen this insidious change take over logical critical thinking practices that nurses depend on to care for their patients safely and for optimal outcomes. Nurses also endure emotional stress when they know a baby is hungry and must wait until the baby develops medical complications to supplement them. Unless medically necessary, the rule is no formula, and prevention is not part of the Baby-Friendly protocol.

Nurses also experience emotional stress from the fear of consequences when making choices to protect their patients that go against the Baby-Friendly protocol. One such example is taking a baby to the ‘false’ nursery so a single mom with no support can get some rest and sleep and not have to worry about taking care of her baby and herself. I’ve experienced sadness witnessing other nurses accept this policy, and I mourn the loss of the nursing practices based on evidence-based guidelines and individualized care.

The Emotional toll on The Physicians

 I’ve seen physicians who seemed reluctant to talk to lactation about their concerns, which was troubling to me. I will never forget the pediatrician who argued with the lactation consultant  about supplementing and finally said, “the bottom line is- I’m the physician.” From then on, his babies were supplemented without consequences for the nurses. 

The Baby-Friendly protocol has glaring omissions of supporting and protecting maternal mental health, namely psychological or social considerations that mothers face. We must develop and practice patience-centered evidence-based care for the best parenting outcomes. 

I would say to the BFHI supporters that exclusive breastfeeding can be good and works well for some. Still, I would like them to admit that it does not work for every mother because not every mother produces enough colostrum for her baby, and not every mother can take care of their baby or themself after delivery. 

~Irene Ford

#fedisbest

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Additional blog links from nurses and doctors

Nurses Are Speaking Out About The Dangers Of The Baby-Friendly Health Initiative – Fed Is Best

Q&A: One Nurse’s View on Strict Breastfeeding Policies

Dr. Nicole King Warns About Dangers of Baby-Friendly Hospital Initiative at USDA Dietary Guidelines Meeting – Fed Is Best

Hospital Drops Baby-Friendly Program After Doctor’s Baby Was Harmed – Fed Is Best

Two Physicians Describe How Their Baby-Friendly Hospital Put Their Newborn in Danger – Fed Is Best

Writing Your Hospital and the Joint Commission About Your Baby’s Feeding Complications – Fed Is Best

If I Had Given Him Just One Bottle, He Would Still Be Alive. – Fed Is Best

NICU Nurse Discloses Newborn Admission Rates From Breastfeeding Complications in BFHI Unit – Fed Is Best

From a Pediatric Nurse Practitioner, “You Are Not Alone.” – Fed Is Best

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