On October 14, 2019, theJournal 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:
any breastfeeding at 6 and 12 months
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 →
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.
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.)
I am sharing my story because I know new parents are struggling with lactivism right now; they need to hear my story to protect themselves. It was lactivism that compromised my mental health, and it was lactivism that caused my child to suffer.
I thought lactivist rhetoric existed only on social media, but I was wrong. It’s also part of our medical institutions and is harming moms and babies.
When I was pregnant, I wasn’t sure how I wanted to feed my baby, so I planned to try breastfeeding and switch to formula if it didn’t work. After her birth, my daughter had a difficult time breastfeeding. My nurse told me that babies are born to breastfeed, so I should keep trying until she does. I stayed up all night with her trying to breastfeed, but she just wouldn’t for more than a few minutes and would fall back asleep.
I was concerned my baby was not getting enough colostrum. Every medical professional assured me that her wet and dirty diaper count was normal and meant she was getting enough. I trusted they knew more than I did as a first-time parent, but my baby was now crying and still was not breastfeeding well. When I attended breastfeeding classes at my hospital, the instructor told us crying is the last sign of hunger.
When the lactation consultant came, she saw my baby screaming, not nursing. I practically begged her for baby formula, but she firmly said everything was normal and insisted babies don’t need much milk in the first days of life. She told me formula would mess up my milk supply, cause obesity and nipple confusion, and provide “instant gratification.”
The lactation consultant provided misinformation and was overtly wrong.
After she left, I broke down and cried uncontrollably; I knew she wasn’t getting enough milk out of my breasts, but no one cared. Every health professional watched my baby scream in hunger, but supplementing her was not supported or offered. I was told repeatedly that her crying was normal and that my milk would soon come in if I continued breastfeeding her.
That’s when I realized how damaging lactivism was. They didn’t care about my baby being hungry. They only cared about breastfeeding. There’s no denying that this was *ucked up!
Nurses are given text scrips to respond to parents asking for formula supplementation.
Maybe this is why 1 in 71 exclusively breastfed babies are rehospitalized for complications of insufficient colostrum intake. Babies are forced to endure hunger and thirst until they meet thresholds to warrant “medical necessity.”
Due to our desperate situation, my husband suggested that I use the pump I had brought, so I began pumping milk. I fed her all the milk I pumped, and she gulped it down. She stopped crying and slept for hours.
She was STARVING, BUT NOBODY CARED.
I continued to pump, hoping she would nurse, but she didn’t. I dreaded telling her doctor I was pumping and bottle feeding my baby. The guilt consumed me during my most vulnerable time as a new mother.
Why would I feel guilty for providing my child pumped milk?
It was clear to me, looking back, that I had been brainwashed into thinking I needed to breastfeed my child to be a good mother. The effects of lactivism are devastating emotionally; they are insidious, unrelenting, and harmful. I shudder to think about what would have happened to my baby if I hadn’t pumped in the hospital.
I was lucky to find parenting communities where I learned that any valid feeding method (including pumping) is healthy for my baby. I was fortunate to hear the words “fed is best.” And I was lucky that someone told me to value my mental health over breastmilk.
Was your baby denied supplementation in the hospital? Please get in touch with us to share your story. Every story saves another child from experiencing the same and teaches another mom how to feed her baby safely. Every voice contributes to change.
Please consider making a donation to the Fed is Best Foundation. We are using funds from donations to cover the cost of our website, our social media ads, and our printing and mailing costs to reach health providers and hospitals. We do not accept donations from breast- or formula-feeding companies, and 100% of your donations go toward these operational costs. All of the Foundation’s work is achieved via its supporters’ pro bono and volunteer work. Thank you!
Is Modern Day Breastfeeding Advocacy really feminist?
Breastfeeding advocacy is often characterized as feminist, and many people in the current breastfeeding advocacy community would describe themselves as feminists. Feminism, after all, is not just about demanding equality to men; it is about valuing women—our brains, bodies, and work—as much as we do men’s. Breastfeeding and the provision of human milk is work, and many feminists—rightfully—expect that work to be valued.
Modern breastfeeding advocacy started in the 1950s; La Leche League International (LLLI) began as a grassroots organization of women who wanted to breastfeed their babies and assist other interested mothers in doing so. Founders Marian Tompson and Mary White had experienced breastfeeding problems with their first children, leading to unwanted weaning; after successfully breastfeeding subsequent children and learning that many other mothers had been in the same position (bottle-feeding formula out of necessity rather than choice), they organized a group dedicated to helping others who wanted to breastfeed successfully.
Jessica Pratezina, MA, is a Ph.D. student in Interdisciplinary Studies (Child and Youth Care; Sociology) at the University of Victoria, British Columbia, Canada. Her doctoral research studies gender equality, father involvement, and early family formation.
Yet,gender equality isn’t one of the topics parents are encouraged to discuss during their parenting transition. In between learning how to clip those impossibly tiny newborn fingernails and piecing together cribs that seem to require an engineering degree to assemble, talking about how to keep childcare and housework tasks fair and equal isn’t something most couples are supported to do.
Gender equality is also not usually discussed as a factor influencing parents’ feeding choices. When I worked as an infant development specialist, I was taught to ask all sorts of questions about a mother’s feeding plans. The intention was to guide (or possibly guilt) the mum into choosing exclusive breastfeeding.
I was never taught to ask a mum how she wanted to involve the baby’s dad in feeding and how the different feeding options might support or hinder an equal sharing of the baby’s care.
In most hospitals and prenatal educational materials, exclusive breastfeeding (EBF) is the recommendation for infant feeding. EBF is promoted as the only healthy way to feed a baby, with partial breastfeeding, temporary supplementation, and formula feeding falsely characterized as “suboptimal.” Other infant feeding options, such as exclusive pumping or formula supplementation, are discouraged, even when requested by parents. But does this narrow definition of healthy infant feeding support patient rights and ethical infant feeding principles? No, it does not.
Infant feeding support in postpartum units should consider ethical principles of autonomy, beneficence, justice, and non-maleficence when considering the extent to which lactation should be promoted.
What Are The Principles of Ethical Infant Feeding?
Autonomy: The parents choose how they intend to feed their baby at each feeding, and maternal bodily autonomy is affirmed and respected.
Beneficence: The benefits of infant feeding types are provided to the parent to help them make an informed decision. Healthcare providers must not decide what is best for the parent.
Justice: Do not assume a feeding method. Ask the parent how they want to feed their baby. Affirmative consent must be obtained before touching a patient’s body.
Sarah Christopherson is a mother and the Policy Advocacy Director at the National Women’s Health Network, a non-profit advocacy organization in Washington, D.C. She talks about her breastfeeding experiences and her recent experience in a Baby-Friendly hospital where her child became severely dehydrated and lost 15% of her birth weight while in the hospital. She discusses how policies can negatively affect patient health and how systemic change is needed to support positive patient health outcomes and prevent patient coercion.