The Illusion of Choice: Baby Friendly USA Says Newborns “Should” Room In With Their Mothers

by Jody Segrave-Daly, Veteran NICU/Nursery nurse, IBCLC retired and Cofounder of the Fed Is Best Foundation 

The standard of care for most hospitals, especially those who are Baby-Friendly certified, is that mothers stay with their baby after birth in their room, 24 hours a day, which is known as rooming-in.

Baby Friendly’s recent blog says that mothers have choices about nursery care in their Baby-Friendly certified hospitals; but then they say babies SHOULD stay in the room, no matter how they are being fed. This statement gives parents mixed messages and implies they don’t really have a choice at all. In many hospitals, it is not just implied; nurseries have been eliminated outright. 

“Regardless of whether a mother is breastfeeding or formula feeding, they should room-in with their newborn.” 

 – Lori Feldman-Winter, MD, MPH 

According to the World Health Organization, rooming in began as a way to promote early breastfeeding and to encourage bonding. Step 7 of the Ten Steps to Successful Breastfeeding calls for hospitals to “enable mothers and their infants to remain together and to practice rooming-in 24 hours a day.” 

Despite the WHO’s 2017 expert panel’s finding that 24/7 rooming-in was ineffective at promoting sustained breastfeeding after discharge (but recommended it any way) and published tragedies of harmed infants while rooming-in, The World Health Organization and UNICEF continue to include rooming in for healthy newborns in the Ten Steps to Successful Breastfeeding policy.

Since adopting the rooming-in policy, inexcusable consequences such newborn falls from parent beds and near deaths and deaths from accidental suffocation while breastfeeding or doing skin-to-skin care (known as Sudden Unexpected Postnatal Collapse or SUPC) have skyrocketed, highlighting the urgent need for families to have access to nursery care. 

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How Do Misogyny and Feminism Impact the Breast is Best Narrative?

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.[1] Breastfeeding and the provision of human milk is work, and many feminists—rightfully—expect that work to be valued.[2]

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. 

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A Nurse Speaks Out About The Emotional Distress Parents Endure From Mandated Exclusive Breastfeeding Policies

“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

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Mother Speaks Out About Her Baby’s Death After Exclusive 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. 

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I HAVE SO MUCH REGRET NOT QUITTING BREASTFEEDING EARLIER; WE SUFFERED AND FEEL VERY LET DOWN BY PROFESSIONALS AROUND ME FOR BEING SO ANTI-FORMULA

Knowing now how many babies have been lost or suffered an injury due to insufficient nutrition and dehydration in those early days, I feel so much anger towards those staff who dismissed my concerns, as we could so easily have gone the same way. By this point, my son’s urine was like brick dust and barely meeting the minimum frequency—but home we went, away from any medical supervision. 

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