U.S. Study Shows Baby-Friendly Hospital Initiative Does Not Work

by Christie del Castillo-Hegyi, M.D.

On October 14, 2019, the Journal of Pediatrics published astonishing findings regarding the effects of the Baby-Friendly hospital certification on sustained breastfeeding rates as defined by the 2020 Healthy People Goals of: 

  1. any breastfeeding at 6 and 12 months
  2. exclusive breastfeeding at 3 and 6 months. 

They did so by measuring the relationship between statewide breastfeeding initiation rates data and the above breastfeeding rates. They then measured the contribution of Baby-Friendly hospital designation on these same breastfeeding outcomes.

According to the study authors, the increase in hospital designation in the Baby-Friendly Hospital Initiative (BFHI) began in 2011 when the U.S. Surgeon General issued a call to action for maternity care practices throughout the U.S. to support breastfeeding. The Centers for Disease Control (CDC) became involved in promoting the BFHI policies in hospitals and health facilities, as breastfeeding was thought to be associated with lower rates of childhood obesity. The assumption was that by increasing breastfeeding rates through the BFHI, there would be a concomitant decline in childhood obesity. Upon initiation of this program, the CDC initiated surveillance of state-specific data on breastfeeding outcomes after discharge including BFHI designation rates. This data is made available to the public through the CDC Breastfeeding Report Card, which provides annual reports from 2007 through 2014 and biennial reports from 2014.

As expected, they found that states with higher breastfeeding initiation rates had higher rates of these sustained breastfeeding outcomes. You cannot have high breastfeeding rates unless mothers are given education and successfully initiate breastfeeding. However, when they measured the effects of Baby-Friendly certification, this is what they found.

“Baby-Friendly designation did not demonstrate a significant association with any post-discharge breastfeeding outcome (Figures 1, B and 2, B). There was no association between Baby-Friendly designation and breastfeeding initiation rates.” Continue reading

World Health Organization Revised Breastfeeding Guidelines Put Babies at Risk Despite Pleas from Experts—Informing the Public “Not a Top Priority”

By the Senior Advisory Board of the Fed is Best Foundation

A key recommendation of the 1989 World Health Organization Ten Steps to Successful Breastfeeding which guides the Baby-Friendly Hospital Initiative (BFHI) is: “give infants no food or drink other than breast-milk, unless medically indicated.” This has led to serious complications from accidental starvation of babies, including dehydration, hyperbilirubinemia (jaundice) and hypoglycemia (low blood sugar) — known causes of infant brain injury and permanent disability. Last week, the WHO issued draft revised breastfeeding guidelines, failing to revise this recommendation. These guidelines define the standard of care for breastfeeding management in all healthcare facilities worldwide. Nearly 500 U.S. hospitals and birthing centers and thousands more worldwide that meet the criteria of the BFHI are certified as Baby-Friendly, adhering to the application of the WHO’s Ten Steps.

On Sept. 22, 2017, senior members of the Fed is Best Foundation, and guests including a neonatologist from a leading U.S. tertiary care hospital and a pediatric endocrinologist, Dr. Paul Thornton, M.D, from Cook Children’s Hospital Fort Worth, lead author of the Pediatric Endocrine Society’s newborn hypoglycemia guidelines, met via teleconference with top officials of the WHO Breastfeeding Program: Dr. Laurence Grummer-Strawn, Ph.D., Dr. Nigel Rollins, M.D. and Dr. Wilson Were, M.D. to express their concerns about the complications arising from the BFHI Ten Steps and to ask what, if any, monitoring, research, or public outreach the WHO has planned regarding the risks of accidental starvation of exclusively breastfed newborns. The Foundation members who attended were 1) Christie del Castillo-Hegyi, MD, Co-Founder, 2) Jody Segrave-Daly, RN, IBCLC, Co-Founder, 3) Julie Tibbets, JD, Partner at Alston & Bird, LLP, Pro-Bono Attorney for the Foundation, 4) Brian Symon, MD, Senior Advisor, and 5) Hillary Kuzdeba, MPH, former quality improvement program coordinator at a children’s hospital, managing infant feeding projects and Senior Advisor.

Emails confirming meeting between the WHO and the Fed is Best Foundation available here.

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If I Had Given Him Just One Bottle, He Would Still Be Alive.

by Jillian Johnson with commentary from Dr. Christie del Castillo-Hegyi

Landon would be five today if he were still alive. It’s a very hard birthday–five. It’s a milestone birthday. Most kiddos would be starting kindergarten at this age. But not my little guy. I wanted to share for a long time about what happened to Landon, but I always feared what others would say and how I’d be judged. But I want people to know how much deeper the pain gets.

I share his story in hopes that no other family ever experiences the loss that we have.

Jarrod and I wanted what was best for Landon as every parent does for their child. We took all of the classes. Bought and read all of the books. We were ready! Or so we thought….every class and book was geared toward breastfeeding and how it’s so important if you want a healthy child. Landon was born in a “Baby-Friendly” hospital. (What this means is everything is geared toward breastfeeding. Unless you’d had a breast augmentation or cancer or some serious medical reason as to why you couldn’t breastfeed, your baby would not be given formula unless a prescription was written by the pediatrician.)

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Things We Wish We Knew About Breastfeeding Before We Started

Parents from the Fed is Best Infant Feeding Support group have told us that their prenatal education didn’t prepare them for the realities of breastfeeding and didn’t teach them the education they wanted and needed. They want other families to be informed to have a safe and positive breast/chestfeeding experience.  This is what they said: 

“It’s really, really difficult!”

It does not come naturally to babies or parents; it’s a learned skill, and sometimes things go wrong. You don’t just stick your breast in the baby’s mouth and call it a day! It’s hard! It’s not as easy as the classes or videos make it seem. (Remember, they’ve all been practicing!).”

It can take a mental toll—stress, depression, anxiety, isolation.”

“Breastfeeding was the hardest thing I ever loved to do!”

“It does (for most of us) absolutely hurt, even if you have the right latch. It’s normal for it to hurt for the first few seconds, with letdown and latching.  But it’s not supposed to be overwhelmingly painful long-term. (Also, nipple vasospasms are a thing.).”

“It does do NOT prevent postpartum depression—and it can sometimes make it worse.”

“You might actually gain weight—it might make you super hungry.”

“Mastitis is no joke! Neither are milk blisters, cracked nipples, clogged milk ducts, leaking, etc.”

“It’s OKAY to have your own strong feelings about feeding. Yes, fed is best, and feeding the baby safely is the priority- but it’s totally fine if you really want to breastfeed and put more work into it than others feel is reasonable. It’s okay if you have an irrational attachment to a pretty can of formula even though you know they all meet the same standards.” – Jarren Bennett

“It can feel incredibly isolating and stressful being the only one that can feed them.” Continue reading

Is Breastfeeding Twelve or More Times a Day Normal? Not Always

A meme posted by an IBCLC states that breastfeeding 12 or MORE times a day is “normal” with no further education on when it can be a sign of newborn hunger, poor feeding, inadequate milk transfer, or failure to thrive. 

Overly simplistic memes like this are irresponsible, confusing and in some cases are the reason why parents miss red flags that require medical attention and lactation assessment to be sure the baby is receiving adequate nutrition and fluids when nursing. (Source of meme to the left, Facebook, Lucy Ruddle, IBCLC)

Here at the Fed Is Best Foundation, we receive messages frequently from families who tell us they were repeatedly assured by trusted health professionals that nursing 12 or more times a day is completely normal. 

But is it always normal?

No, it’s not.  Continue reading

Trouble Breastfeeding? It’s Not Your Fault  

by Heidi Bitsoli, Sunshine Behavioral Health 

If there’s one thing pregnant women get in spades, it’s advice. From your relatives to your neighbors to your coworkers to strangers in line at the grocery store, everyone has an opinion on how to best care for the child you’re about to birth.

And one of the most common pieces of advice you’re likely to hear is how important breastfeeding is, for both mother and baby. But what all those opinionated folks won’t tell you is how hard it is for some women.

The truth is, that your mental and physical health is just as important as your baby’s. If you have trouble breastfeeding, or simply decide it’s not for you, you are not alone. You also aren’t a failure as a parent if you have difficulties breastfeeding or decide against it.

How Common Are Breastfeeding Difficulties?

Breastfeeding difficulties are extremely common. One study conducted by Nutrients followed mothers who were breastfeeding when they were discharged from the hospital, within 72 hours of delivery. At the time of discharge, 95% of the mothers were breastfeeding exclusively.

After one week, 81% were still breastfeeding exclusively. The majority of these women continued with complementary breastfeeding. At one month, only 73% were exclusively breastfeeding. 19% still provided breast milk complementary feedings, and 7% had transitioned to exclusively formula feeding. Continue reading

Belgian Mother Shares How Her Babies Became Lethargic After Being Denied Supplemental Milk by Hospital Staff

A Letter from Karlyne C. from Belgium

I would like to share my experience, in hopes that it can be of some use. My name is Karlyne, I am the mother of 3 children and I live in Belgium. 

My first daughter, Moïra, was born in 2018. I had not looked up any information about breastfeeding during my pregnancy, I thought that since it is a natural process, it would be easy and that there was nothing more to know than the fact that I should put the baby on breast when she showed signs of hunger. When she was born, that is what I did, I put her on my breast.

But she could not manage to latch on, she would systematically let go of the breast. I asked the midwives who worked in the maternity ward for help. They would crumple my nipples while firmly holding her head to try to shove them in her mouth despite her cries. Hours went by without her being able to feed, and I could tell she was getting weaker, all the while the midwives were telling me that everything was normal. In response to my insistence, I was told to express colostrum in a small spoon, and to give it to her, if it could reassure me. I produced at most a few drops of colostrum, yet the midwives kept telling me that I had enormous quantities, and that a baby’s stomach is minuscule, that some 5 halves of those small spoons every 2 to 3 hours would be more than enough. Those few drops, Moïra refused because the spoon in her mouth made her nauseous, so she would not take it.  The midwives refused to bring me a clean spoon for me to try again, telling me that supplementing once was enough. 

As days went by, Moïra stopped crying, Moïra stopped reacting, she was completely inert. Her [glucose levels were] no longer even measured, although I had been diagnosed with gestational diabetes, which placed her at higher risk for hypoglycemia from the get-go. I kept desperately asking for a bottle to feed her, and it was systematically refused, with the reply: “You said that you would breastfeed, so you will breastfeed.” My loved ones who visited with me refused to bring me a bottle and formula, telling me that I should trust the medical professionals who knew best what I had to do.

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MOTHER SPEAKS OUT ABOUT HER BABY’S DEATH AFTER BEING TOLD TO KEEP EXCLUSIVELY BREASTFEEDING: WHAT SHE WANTS HUMAN RIGHTS ORGANIZATIONS TO KNOW

Josephine contacted us after reading Dr. Christie del Castilo-Hegyi’s letter to health care professionals about the dangers of insufficient breastfeeding and the Baby-Friendly Hospital Initiative. Josephine is from Lagos, Nigeria, and wants to tell her story, because she believes every mother should know how to supplement her baby safely until her milk is flowing, no matter what country she lives in, to prevent brain damage and death from insufficient breastfeeding. 

She writes: After I gave birth to my son, my baby was very hungry and cried inconsolably. I was concerned there was no milk coming out of my breasts. I told my husband to go buy baby milk to give to our son until my breast milk flowed. But my doctor was opposed to this idea, saying that exclusive breastfeeding is the best. I listened to my doctor but was confused because there were four mothers in the general ward (hospital) with me whose breasts didn’t flow immediately either. Two of the mothers amongst us didn’t follow the instructions of the doctor. They bought baby milk to supplement their babies, while I and the one other mother were waiting for our breast milk to flow.

I noticed in the hospital ward that my baby, and that of the other mother whose milk wasn’t flowing, cried inconsolably, while those other babies on supplements were sleeping. The only time those babies cried was when they were hungry.

I told the doctor during the ward round what I observed, and he said my baby would be fine. The new nurses knew I had no milk, so they told me (secretly) that I should get baby milk supplements and feed him, and then when my breast milk started flowing, I should discontinue the supplements. But I listened to my doctor. 

Complications related to underfeeding exclusively breastfed newborns are the leading causes of newborn hospitalizations globally. These complications include jaundice, hypoglycemia, and dehydration, all conditions prevented with adequate and timely supplementation when breast milk is not enough. Every mother can protect her child from these complications by knowing the signs of a HUNGRY child. Josephine’s baby was most likely experiencing hypoglycemia from the way she described his crying.

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Dear pediatricians, watch your language; infant bonding happens with a present loving parent not the way they are fed

 

Dear Pediatrician, 

I am writing this letter to open my heart to all pediatricians. I’m hoping that sharing my story will encourage them to watch their language when talking to parents about infant feeding.

As a parent, we naturally want to make sure our children thrive. We entrust pediatricians to care for our children with unbiased and evidence-based information. We rely so heavily on your assurance that we are doing right by our children. We need the “you’re doing great” or “maybe try doing this instead” to help guide us through the ups and downs of parenting these little ones that did not come with an instruction manual. 

Recently, I was at a pediatrician appointment with my second baby, who happens to be exclusively breastfed. Breastfeeding was easier for me the second time around, and my mental state is in a much better place. 

My pediatrician began to examine him. He starts to cry as he does with everyone that isn’t mommy, daddy, or big sister. She looks at me and laughs and says, “yup, he is definitely in the stranger-danger phase now. And I bet it’s even stronger because he is breastfed. Breastfeeding just creates this unexplainable bond.”

I stood there dumbfounded and in disbelief. My pediatrician knows my daughter was formula-fed, and she knows how emotional I was when switching her to formula. But even putting that aside, she is supposed to be a trained professional and understands that breastfeeding doesn’t create “an unexplainable bond” —bonding happens with an emotionally healthy, loving parent, not by the way a baby is fed. I don’t feel a stronger bond with my son than I do with my daughter. They are both my babies, and I love them both equally and unconditionally. 

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How To Prepare For Supplementing When Breastfeeding Your Baby In The Hospital

Mothers who experienced delayed onset of milk production or experienced low milk supply with their first baby often contact us for support to try breastfeeding again. They typically have anticipatory anxiety, because they have lost trust in their lactation professionals and hospital staff and are unwilling to attempt breastfeeding again without supplementation. They want to know how to supplement their baby until their milk supply becomes sufficient to feed their baby safely while providing proper stimulation to their breasts for optimal milk production.

The most common concerns expressed:

 

  • Fear of the pressure to exclusively breastfeed
  • Fear of failing to breastfeed again
  • Fear of advocating for themselves and their babies while in the hospital
  • Fear of being shamed by hospital staff when wanting to supplement until their milk comes in
  • Fear of being denied formula or not receiving it in a timely manner
  • Triggers from the previous negative breastfeeding experience, such as being touched without consent

Monica writes: “I lost confidence in breastfeeding because I didn’t make enough milk for my first son, who required hospitalization for severe jaundice and a 13% weight loss. I was devastated and furious when the neonatologist told me he was starving. In my birth hospital, my son had been forced to cry from hunger, and I was told my body would make enough milk for him by every lactation consultant and nurse in the hospital. I trusted them. They were wrong! I no longer trusted breastfeeding and decided to pump and bottle feed to ensure he got enough milk. I purposely delivered my second baby at a hospital that didn’t force me to breastfeed exclusively. After starving my son,  I was not taking any chances, and I supplemented my daughter after every breastfeeding session. My breastfeeding experience was the opposite of my son’s, and I remember tearing up several times because she was so peaceful and never cried.  Thankfully I supplemented her because it took five days for my milk to come in. Supplementing saved my breastfeeding journey, and we are still breastfeeding 19 months later.”

 

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My Son’s Life was Forever Changed Due to Insufficient Feeding While Exclusively Breastfeeding

By Pam Floyd

I am the mother of a 28-year-old who is neurologically and physically disabled. My son Chaz, fell victim to severe dehydration called hypernatremia due to insufficient milk intake from exclusive breastfeeding in the first days of life. I read breastfeeding books, watched breastfeeding videos, and studied every page of What to Expect. Unfortunately, following the advice of our lactation consultant and pediatrician’s advice resulted in Chaz going 6 days with absolutely no milk intake, requiring admission to the ICU and a drug-induced coma. Chaz was eventually diagnosed with seizures, developmental delay, and cerebral palsy.

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The New Seven Letter “F” Word

As soon as the word “formula” rolls off your tongue and leaves your mouth for everyone to hear, uncomfortable silence occurs. Parents are reluctant to talk about or admit freely they feed their babies infant formula. Most are suffering from the deeply entrenched shame and judgment that is associated with formula feeding; they have experienced it first hand in countless social media parenting groups, from friends, their health care professionals, WIC offices, and even in their hospitals.

How did we get to the place where talking about infant formula is profoundly divisive, shameful, and anxiety provoking for parents? 

 Let’s face it, infant FORMULA is the new seven letter F word. The scarlet letter F.  FAILURE. 

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