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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Hospital Bag Packing Tips for You and Your Partner

by Josh Moore from Diaperdads.org

Image via Pexels

Packing your hospital bag can be one of the most exciting parts of preparing for your new baby. It’s getting real! But as exciting as it is, many first-time parents feel stressed about what to pack and bring. The Fed is Best Foundationprovides infant-feeding education and can help ease parental jitters. Then you can focus on the fun parts — packing your bag like a pro and visualizing your ideal birth. Read on for tips about how to get started.

Your baby’s first need is you.

The list of baby supplies can feel overwhelming, but try to remember that you are what your new baby needs most of all. The first hour of skin-to-skin contact with your baby has powerful physical and emotional benefits. The comfort and love that you provide your baby immediately after birth are more important than any supplies you bring to the hospital.

That said, there are a few things that you should pack for him or her, such as onesies (including a full body suit), a swaddle blanket, a beanie, and (most importantly) an installed car seat to take your little one home. Your hospital or birthing center usually provides diapers and wet wipes. But keep in mind that if you do forget anything, a friend or relative can bring it to the hospital for you, so there’s no need to pack your baby’s entire future wardrobe. Continue reading

Why Fed Is Best: From One Therapist’s Point Of View

Written by Sarah Edge

I am a Counsellor Psychotherapist, specialising in postnatal mental health in the United Kingdom. I am also a Mum of two small children. I recently wrote a guest blog on “The Process of Healing From Infant Feeding Trauma, Guilt, and Shame: When You Wanted To Breastfeed and Couldn’t” for the Fed is Best Foundation, and when I was asked to write again, I jumped at the chance. In this piece, I aim to examine the Fed is Best message through my therapist lens and discuss why the Fed is Best message is an essential part of healing and recovery. 

It is well known amongst those in the psychology field, whether it be researchers, psychologists, or therapists, that people are often drawn to study and work in a field where they have personal experience. The well-regarded and highly accomplished trauma academic Bessel Van Der Kolk has described his own research as “self-search.” And most have heard of the phrase “the wounded healer.” I am no different. I became interested in working therapeutically with postnatal mental health and infant feeding guilt due to my own experience of breastfeeding difficulties.

I personally have a complicated and emotional relationship with infant feeding. I experienced formula feeding my firstborn and breastfeeding with my second child. I have personally undergone my own therapy and recovery, meaning I am now able to work safely and supportively with other women experiencing psychological distress compounded by, or sometimes caused by, their infant feeding experiences. But that’s not to say my heart doesn’t ache when I hear a mother shares her raw and moving story of when breastfeeding didn’t work out. Continue reading

Do Parents Need To Boil Water For Powdered Infant Formula Preparation in the United States?

Written by Jody Segrave-Daly, MS, RN, IBCLC

Boiling water for powdered infant formula preparation is one of the most conflicting and confusing topics for parents. Our governing bodies such as the CDC, WHO, WIC, AAP and FDA, all have varying recommendations for preparing formula. 

Seventy-five percent of infants in the US will receive some infant formula by 6 months of age. Safe infant formula preparation education is very important to ensure babies are fed safely for optimal growth and health outcomes.  Parents have shared some of the educational materials they received for formula preparation, and there were vast differences ranging from a one-page handout to a complete step-by-step instruction booklet. Most parents said they were not told to boil water.

Infant Formula Regulation In The United States

Infant formula products in the US have the most rigorous regulations in the world. In 1980 Congress passed the Infant Formula Act and the 1986 Amendment which, along with the current edition of the Infant Formula Program, established nutrient requirements for all infant formulas. The American Academy of Pediatrics’ Committee on Nutrition develops the nutritional standards and are used by the Food and Drug Administration to develop infant formula regulations. 

The Infant Formula Act of 1980 is one of the most specific and detailed acts ever passed by Congress. It establishes nutrient requirements, defines adulteration, provides for establishing nutrient and quality control procedures, prescribes recall procedures, and specifies inspection requirements.

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The Baby-Friendly Hospital Initiative is The Worst Thing I Have Experienced in my 20 Years as a NICU Nurse

Dear Parents,

It’s taken me years to find the courage to contact the Fed is Best Foundation with my experiences of working in a baby-friendly hospital.  “Baby-Friendly” is the worst thing I have experienced in my 20 years as a NICU nurse. My colleagues and I have tried many times to express our concerns with the number of NICU admissions we receive. Eighty percent of our admissions are because of baby un-friendly protocols for hyperbilirubinemia, hypoglycemia, excessive weight loss, and dehydration in our hospital from insufficient breastfeeding. We are a small unit, and we have had around 150 plus admissions last year from insufficient feeding. Sadly, we’ve had bad outcomes.

Many of my colleagues are very frustrated….but others have drank the kool-aid—believing drops of colostrum are all the baby needs—which is blatantly false. The lactation nurses audit charts daily and report nurses for supplementing babies, then they go to moms’ rooms to reeducate them on the “dangers” of formula—another blatant lie. The nurses who are reported must have a counseling session with management for supposedly “overfeeding” and not following “baby-friendly” protocols. Continue reading

The Process of Healing from Infant Feeding Trauma, Guilt, and Shame: When You Wanted to Breastfeed, but Couldn’t

My name is Sarah Edge, and I am a counsellor psychotherapist and mum of two. After my experience with breastfeeding trauma, guilt, and shame, and the associated decline in my mental health after the birth of my son, I was motivated to start my own practice specialising in postnatal mental health. 

I suspect that most of you reading this are doing so because you have your own experience of infant feeding guilt or trauma, where breastfeeding didn’t work out how you had planned. My personal story is a tale as old as time. My son was born late preterm, healthy but sleepy and unable to latch. He developed significant jaundice and low blood sugars, resulting in us returning to the hospital, and him being admitted onto the children’s ward at five days old.

I tried everything to breastfeed: nipple shields, continuous pumping, cup feeding expressed breast milk, triple feeding, lactation consultants, and infant feeding professionals. I had alarms set every 90 minutes to feed my son, and I kept this up for almost two weeks without any results. His feeding consultant then prescribed him formula milk, and he began to thrive. He was happy and healthy, and we returned home to start our lives as a family of three, this time formula feeding him. 

My baby was finally thriving but I was not. I was left with so much sadness, jealousy, disappointment, and animosity towards breastfeeding. World Breastfeeding Week was unbearable, as the social media pages were flooded with beautiful photos of babies at breast, and seeing other women breastfeeding sparked this intense and animalistic jealousy I had never felt before. 

So why was I left with all this sadness?

 

Sadness is an emotional pain that is associated with feelings of loss, sorrow, depression, grief, guilt, disappointment, shame, despair, helplessness, fear, and disadvantage.  It can be difficult to shake and needs to be processed.

 

I was personally experiencing grief. I had suffered a loss. Breastfeeding was important to me, and my feelings were—and are—absolutely valid. 

No matter the reasons you could not breastfeed—and there are countless—you are allowed to mourn the loss of breastfeeding. Just because your baby is thriving without breastmilk doesn’t mean you don’t deserve to grieve or ask for support or comfort, especially if healing has been difficult. 

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What Kind Of Water Is Safe For Mixing Formula Powder For My Baby?

Written By: Jody Segrave-Daly, MS, RN, IBCLC

Great question! Educational resources that parents have access to often give them mixed messages about safe formula preparation.  To answer the many questions we receive, we developed an up-to-date evidence-based resource guide for parents about safe formula feeding. We start with water sources available to parents in the United States, specifically. 

Public Water

The United States has one of the safest public drinking water facilities in the world, and it is strictly regulated by the Environmental Protection Agency known as the EPA. Your community’s public water system is routinely tested for safe consumption. The EPA sets legal limits on over 90 contaminants in drinking water. The Environmental Protection Agency’s Safe Drinking Water Hotline is  1-800-426-4791.

Private Well Water

It is estimated that more than 13 million households rely on private wells for drinking water in the United States. According to the EPA, private well owners are responsible for the safety of their water. This website educates well owners on wells, groundwater, and information on protecting their health.   Continue reading

Dear Chrissy Teigen, You Are Right; We Need To Destigmatize Formula Feeding Our Babies

Dear Chrissy Teigen,

Thank you for your Twitter post raising the very important topic of stress, guilt, and sadness when a breastfeeding mother experiences low milk production.  

I could feel the deep despair you expressed through your words because I have supported thousands of mothers, just like you, who felt tremendous guilt and stress when they tried their best to make enough milk.

Can I emphatically tell you something? You and your body did not “fail” with making enough milk. You were failed by the current breastfeeding education and guidelines, which don’t fully inform mothers about their biological and psychosocial risk factors for low milk supply. Instead, parents are taught that every mother can make enough breast milk if she has the right support; but the research tells us that low milk supply is far more common than people realize.   All of the support in the world cannot increase breastmilk supply if your body cannot biologically produce it!       

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I Dropped My Baby in a Baby-Friendly Hospital While I Was Alone Recovering from a Cesarean Section

Step 7 of the Baby-Friendly Hospital Initiative (BFHI) policy requires parents to room in with their baby 24 hours a day immediately after delivery.

Mothers are commonly sleep-deprived and profoundly exhausted after labor and delivery, some laboring for > 24 hours, some recovering from major surgery. They are required to nurse and care for a newborn almost immediately after delivery with few exceptions. Maternal exhaustion has lead to tragic and preventable accidental newborn falls from bed and suffocation from falling asleep while breastfeeding in bed. These accidents have resulted in brain injury, severe disability, and rare deaths in previously healthy infants. The elimination of newborn nurseries by hospitals has increased as a result of the Baby-Friendly policy. These tragic events received the attention of pediatricians and the Neonatology Section of the American Academy of Pediatrics who has published their concerns in the medical journals of JAMA and JAMA Pediatrics and Pediatrics.

In this recent article that was published in pediatrics, In-hospital Neonatal Falls: An Unintended Consequence of Efforts to Improve Breastfeeding, falls that occur when caregivers fall asleep is a consistent theme in the reported series. In a review of patient safety data over a 9-year period, Wallace reported that 150 of 272 neonatal falls occurred after a caregiver fell asleep while holding the newborn.7 Several smaller series report that 36% to 66% of in-hospital neonatal falls involved caregivers falling asleep.1,3,4,12 Not surprisingly, these falls transpired most commonly during the night or early morning hours. Similar to our series, Galuska13 described 5 cases at a single center in which all neonates fell from their mothers’ arms in the early morning hours, continuing to implicate fatigue as a factor. Continue reading

The Letter Not Only Protected Me; It Protected The Nurses Too

The Letter was from my psychiatrist. It was our way of beating a system that neither of us agreed with, or believed was good for my mental health. It provided protection for me to make decisions that went against the Baby-Friendly Hospital mandates. 

The amount of stuff a pregnant woman brings to the hospital for delivery gets progressively smaller, the more children she has. With my first child, I brought three bags; I ended up ignoring 90% of the contents and gave my husband fits when he loaded the car for the ride home. By the time I packed the hospital bag for my third child, everything fit neatly into a small duffel. Even then, I felt like I was overpacking. As long as I had a phone charger, some lip balm, and the Letter, I knew I’d be fine. 

The Letter was new; I didn’t have it for my other two birth experiences.  It was the result of a long, painful journey, and it embodied all of the knowledge I’d gained over the past several years. It represented a feeling of hope I carried with me as I walked onto the labor and delivery floor at my hospital. Things would be different this time. 

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I Had Asymmetric Tubular Breasts; My Breastfeeding Story

Written By Rachel

 As a young girl, I knew something was wrong with my breasts when they began to develop.   I had asymmetric tubular breasts, and it quickly became my biggest insecurity. At the age of 20, I saw a doctor who told me a breast augmentation would “fix” them. Trusting her medical opinion I had breast augmentation surgery. Now they were double the size and sagging from the weight of the implants. It was worse than what they originally were, making my anxiety and insecurities heightened. After a few years, I decided to get them removed by another doctor who specializes in reconstruction surgeries. I got the implants taken out, a lift of the skin and fat removed from my stomach to fill the empty pouches. With two surgeries comes many scars and of course trauma to the breast tissue. 

What are Tubular Breasts

“Tubular breasts” is the name of a condition caused by breast tissue not proliferating properly during puberty. The condition is also called tuberous breasts or breast hypoplasia.

While not extremely common, tubular breasts cannot be considered rare because many women don’t seek treatment. While tubular breasts don’t pose any direct threat to your health, some women may seek to correct it. Tubular breasts can also present problems for women who wish to breastfeed. (source Healthline)

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