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.
On August 11, 2020, Dr. Nicole King, Anesthesiologist, Critical Care Intensivist, Patient Safety Expert and Senior Advisor to the Fed is Best Foundation spoke at the USDA Scientific Report of the 2020 Dietary Guidelines Advisory Committee meeting warning of the dangers and patient rights violations of the Baby-Friendly Hospital Initiative. Watch her address below.
Good afternoon, my name is Nicole King and I am a mother and a physician. As an anesthesiologist and intensive care physician, I am faced with life and death circumstances every day. In no way did I ever consider breastfeeding my child would be as stressful as supporting a COVID patient through their critical illness. Five years ago, I realized how wrong I was.
As a new mother who had had a breast reduction and a physician, I should have known better, but I did not. I fed into the same propaganda, misinformation and fervor around breastfeeding that has grown over the last 30 years as a result of the Baby-Friendly Hospital Initiative and the WHO’s Ten Steps [to Successful Breastfeeding]. I was not informed of its risks and followed the exclusive breastfeeding guidelines, and as a result, my newborn lost excessive weight and was readmitted for dehydration and jaundice.
The current USDA guidelines are filled with the same soft science riddled by confounding factors, that has led to the shaming of women who are unable to exclusively breastfeed for 6 months. The guidelines are an ableist and elitist narrative and read as an invitation to admonish women for failing to produce enough milk for her child. It blatantly ignores research that clearly shows that delayed lactogenesis of mature milk is common, found in up to 40% of first-time mothers and 22% of all mothers, even those who are motivated to exclusively breastfeed. Never mind the 15% of women who are incapable of sustaining breastfeeding past the first month, even with lactation support.
If you are ill and in the hospital, nutritionists are there to calculate the calories needed to feed you in order for you to thrive and recover. Why then are we so easily fooled into thinking an infant who is building muscle, fat and brain cells can be sustained on far less than their caloric needs, purported by the Baby-Friendly policy? If the “biological norm” is put forth as a reason to exclusively breastfeed, then why are exclusively breastfed infants being admitted daily for dehydration, jaundice, and hypoglycemia? Why do we continue to insist on a policy that increases the risk of harm to infants while vilifying supplementation that prevents serious complications? Every day, I protect my patients with medications, machines and nutritional alternatives to overcome so many failures of the “biological norm.” I do this because I too am human and understand that we care and love for each other regardless of our ability to live up to a standard of perfection. Yet we allow babies to become seriously ill by pressuring mothers to achieve this standard of perfection that millions cannot safely achieve. If judicious and humane supplementation is the difference between a hospitalized and a safely breastfed child, then we have failed all mothers and infants in this country by disparaging its use.
The USDA draft policy continues to ignore these realities and thus fails to protect countless infants. National guidelines should never encourage a policy that is directly responsible for the leading cause of rehospitalization of healthy term infants. And most importantly, as a national guideline, it should apply to all mothers, regardless of her ability to breastfeed, across all socioeconomic demographics.
As a mother who followed these guidelines and was led to rehospitalize her own infant, I beg you to consider the plight of all mothers and infants in this country. Every infant deserves to be protected from hospitalization and the complications of an exclusive breastfeeding policy. And their mothers deserve to know that breast milk is but one way to best nourish their children. The USDA is responsible for every child in the US and their policy should reflect this responsibility.
Dr. Nicole King, M.D. is a patient safety expert and Senior Advisor of the Fed is Best Foundation. She is a board-certified anesthesiologist and critical care intensivist.
When my baby was 5 days old, I got a call from the pediatrician we chose before birth. As soon as I answered, she started speaking very fast and explained that Northside Hospital had notified her that one of our son’s Newborn Screening Test results had come back with an abnormal reading; he needed to be evaluated by a doctor urgently, but in the meantime, I needed to be sure to feed him every two hours. I couldn’t even compute all she said, but I explained that we were already in the NICU at Children’s Hospital because of his low body temperature on the first night home from the hospital. We found out that day our son has medium-chain acyl-CoA dehydrogenase deficiency (MCADD).
WHAT IS MEDIUM-CHAIN ACYL-COA DEHYDROGENASE DEFICIENCY (MCADD)?
Medium-Chain Acyl-CoA Dehydrogenase Deficiency, or MCADD, is a rare genetic metabolic condition in which a person has difficulty breaking down fats to use as an energy source while fasting. It is estimated to affect one (1) in every seventeen thousand (17,000) people in the United States. All babies have a newborn screening (NBS) blood test to check for various genetic and metabolic disorders such as MCADD, but it can take five or more days until the results are reported.
Our close call with our baby’s life haunts us, but it propels us to advocate and educate others—about MCADD, yes, but also about the risks of exclusive breastfeeding, before the onset of copious milk production or insufficient colostrum amounts before those crucial Newborn Screening test results are back, which typically takes 5-7 days. We share our story openly and widely, passionately trying to dispel the myths propagated by the “Breast is Best” movement.
Written by an anesthesiologist and Intensivist physician
“The biggest achievement of my life as a physician was stopping my hospital’s Baby-Friendly program after my child was harmed.”
It was September 20th, and we were headed to the hospital for my induction. I was nervous, as any first-time mother would be. I was worried that I was doing the wrong thing, even though I knew the literature, and my physicians supported my decision for an elective induction at 40 weeks. I was already dilated to 4 cm and my baby had dropped way back at 33 weeks. We all thought it would take just a hint of Pitocin, but I labored for 24 hours until my son was born. I was later told that he was born with a compound hand (up by his head), causing the prolonged pushing time and his distress with each contraction.
While pregnant, I had decided to attempt breastfeeding, even though I had had a breast reduction in 2003. I tried to read as much as I could, but honestly, I didn’t have any idea how much information one needed to do something that everyone swore was “best” and “natural.” My baby was born at 4:14 a.m. I thought this would be ideal, because I would have the support and help as I learned how to be a mother, knowing more staff were available during the day. As the first day melted into the first night, nursing became more and more painful, and he needed to feed almost continuously. When he wasn’t feeding, he was either rooting or screaming. Continue reading →
1. Delayed onset of copious milk production is common.
BFUSA: “Delayed lactogenesis is actually increasingly common because the risk factors for it are potentially increasing,” Dr. Rosen-Carole says. “When a baby is born into that situation, the goal is to closely monitor what the baby is doing, instead of giving a bottle right away. “If the baby is hungry and they’re not getting enough milk out of the mother’s breast, then they need to be supplemented,” she says.
FIBF: We have been passionately educating parents about safe breastfeeding since the beginning of our advocacy over 3 years ago with the current scientific studiesthat have confirmed over and over again that delayed onset of milk production and low milk supply are common. We question why it took you so long to acknowledge this deadly and 100% preventable consequence of insufficient breastfeeding? Does this mean you will ban the belly bead stomach models that do not reflect the current science?
Will you please apologize to the thousands of mothers who bravely told their stories of accidental starvation? You have previously tried to discredit their stories, called them “‘anxiety-provoking,” and characterized our foundation as BFHI detractors— simply because we offer a social media platform for mothers to be heard by you. Have you ever heard a mother break down and scream in horror when she learned her baby was starving to death because she followed your breastfeeding education and protocol? We have—over and over again, and it is the most haunting sound. It’s what drives us to fiercely advocate for safe breastfeeding because no other health organization is doing so.
BFUSA: Dr. Bobbi Philipp agrees. “If you see signs that the mother’s milk is insufficient, you need to feed the baby,” she says. “And if the mother is really committed to breastfeeding, you’ve got to bridge the gap in a way that you support her, feed the baby, and don’t undermine the breastfeeding. It’s that simple.”
FIBF: Now that you are acknowledging delayed onset of milk is common, something that we have been passionately writing and speaking about for years, we expect that you will stop calling us “fibbers.”Name-calling is what a child having a temper tantrum does, not what a professional organization should do; the appropriate response to being called out and held accountably, is to take responsibility and revise your guidelines based on current research and patient feedback.Continue reading →
We regularly receive messages from nurses,physicians, LCs and other health professionals. They express their concerns while asking for help and patient resources. They tell us their stories and they need support and direction of what to do about unethical and dangerous policies they are forced to practice. We collected their stories and are beginning a blog series of health professionals who are now speaking out about the Baby-Friendly Health Initiative and the WHO Ten Steps of Breastfeeding.
Dianna Talter, Pediatric Emergency Department Nurse
I am a pediatric emergency department nurse traveler and sometimes, I worked on the mother-baby unit. I will never work on a mother-baby unit again because of the terrible conditions that mothers and babies are forced to endure because of the “Baby-Friendly” (BFHI) protocol!
Mothers were expected to assume full responsibility for their babies and themselves while they were recovering from birth. Mothers were profoundly exhausted and would fall asleep in bed holding their babies. I was taken aback at the number of crying breastfeeding babies who were hungry. To meet the metrics of exclusive breastfeeding rates (80%), we could not supplement the babies and our goal was to get them discharged as exclusively breastfeeding.
Now I know why the emergency department admissions have climbed significantly for hyperbilirubinemia, hypernatremia, hypoglycemia, and seizures. I have worked in a pediatric emergency department for 20 years, and I am appalled at the lack of comprehensive breastfeeding education that is provided to mothers. They are not taught about the signs that their baby is not getting enough milk. These parents are GOOD parents and were following their breastfeeding education guidelines. It’s pure insanity!
I took care of two babies who died needlessly from complications of acute starvation. One baby had a glucose level of 14, sodium level of 160, and was seizing. We did everything we could to save the baby, but it was too late. Her parents were failed by the current breastfeeding education, which is based on the BFHI/WHO Ten Steps. The other baby was stabilized in the ED and was transferred to the PICU [pediatric intensive care unit] only to die the next day.
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 →
Jody Segrave-Daly, RN, IBCLC and Christie del Castillo-Hegyi, M.D.
On October 16, 2019, the Fed is Best Foundation billboard went up on I-95 Northbound, 0.3 miles south of Bridge St. in the heart of Philadelphia. This billboard was purchased with donations from private family and health professional supporters of the Fed is Best Foundation. It was a billboard that did not mince words with regard to the risk of newborn brain injury and disability from insufficient feeding complications, namely phototherapy-requiring jaundice.
Since then, several anti-Fed is Best, lactivist groups have posted about the billboard showing their clear concern about the effects of fully informing the public of these serious risks of the Baby-Friendly Hospital Initiative. We are saddened to see them express little concern about the harm caused to babies and their families by a policy that routinely shames families who choose to use formula, normalizes signs of persistent infant hunger and exaggerates the risks of formula while hiding the risk of brain injury from insufficient feeding while exclusively breastfeeding.
Screenshot from a lactation consultant facebook group
From one of the Fed is Best health professional supporters of this billboard:
If you don’t think this is happening, you’re not paying attention. You are probably getting your information from echo chambers where breastfeeding always works, and you’re ignoring any data that challenges that. We are well aware that exclusive breastfeeding often works fine–are you aware that often it does not? Are you aware of what hypoglycemia and excess bilirubin can do to the brain? Have you been listening to mothers, or reading any research outside of lactation journals?
We get constant emails from families whose babies have suffered levels of hypoglycemia and hyperbilirubinemia known to cause brain injury. Some of these babies are disabled, possibly as a result of those complications. Some of these families have crushing medical debt on top of the anguish of knowing their healthy baby was allowed to starve, and their health care providers did nothing but push continued breastfeeding despite clear signs of inadequate milk intake. These families deserve justice.
Many people refuse to believe that our Foundation can afford this solely through donations, and that industry money must be behind it. Again, have you been listening to mothers? Have you been reading any research outside of lactation journals? You can close your eyes and ears and believe in conspiracy theories about our funding, or you can start listening to mothers who are here in the comments on every post we put up, sharing their stories. They are out there on blogs, news stories, and other media, sharing their experiences with the same problems we are trying to prevent. We will not stop raising awareness for #safebreastfeeding until no more newborns are harmed from dangerous breastfeeding protocols.
Listen. To. Mothers.
The Fed is Best Foundation has received overwhelming support for this campaign since news of the billboard came out. As a result of several generous donations from the Fed is Best community, we have enough to purchase our next billboard! Thank you to all our generous supporters who have helped up spread the Fed is Best message. Together, we have changed the conversation regarding infant feeding to prioritize respect, inclusion, and most of all, safety for every child, regardless of the way they are fed.
This is going to be the next billboard coming your way!
To help the Fed is Best Foundation put up a billboard in a major city, please consider making a donation of any amount to our organization. Please leave in the comments your vote on what city should be next!
I’m an IBCLC who supports the Fed is Best Foundation. Probably many of you who read this are going to roll your eyes and assume I’m just their sock puppet, but for those of you who are still listening, I’m going to tell you why I support an organization who talks about the “risks of exclusive breastfeeding” and states that the Baby-Friendly protocols “endanger newborns.” I know better than to put my name to this because I don’t want to subject myself or my children to what other supporters have faced—unspeakably cruel messages and literal death threats. I wish I were making this up.Continue reading →