Category: Breastfeeding And Safe Infant Feeding Educational Resources

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

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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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I Had All of The Support In The World And Breastfeeding Still Didn’t Work.

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They tell you that if you prepare enough, breastfeeding will work. They tell you that all you need is support, commitment, and trust in your body, and you will be successful. If only it were that simple.

What they don’t tell you is that your mammary biology can have limitations. I am that mom. 

I knew I might have issues. I had breast reduction surgery back in 2001, but had been told that using the right technique would preserve my ability to breastfeed. Nonetheless, I set out preparing to ensure I would be successful. Besides doing yoga, pilates, weight training, and exercise, I entered the midwife program and prepped diligently. I did prenatal workshops and tracked down a book on how to successfully be a breast feeding after reduction mom.

I hired a private lactation consultant for a session ahead of time. We talked about teas and tinctures, techniques, and diet to help my supply be optimal. (Note: there is no evidence that teas, tinctures, or foods increase milk supply). We talked about how I could use a supplemental nursing system if necessary. I read extensively and was convinced breastfeeding was the only way to feed my son to ensure his well-being, and I would have no problem breastfeeding because I had SUPPORT. 

Note: Unfortunately, she was not informed of all her significant risk factors and how to supplement her baby until her milk supply was enough to feed her baby safely. Breast reduction surgery requires specific management and interventions that she did not receive.

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The Ten Steps to Ethical, Successful, And Inclusive Infant Feeding

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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. 

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Why it’s Time to Stop Teaching Parents Paced Bottle Feeding and Teach Responsive Feeding As Recommended by the AAP

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Paced bottle feeding is a wildly popular bottle feeding technique that is promoted as the best way to feed babies who are breastfed. When I did a google search for paced bottle feeding, there were a whopping 572,000,000 results! What’s more, definitions of paced bottle feeding techniques varied significantly, often contradicting each other,  and there were many unproven claims to promoting paced feeding. 

As a 31-year NICU nurse and lactation consultant, I’m mystified why paced feeding for healthy term babies has become the norm. Pace feeding is a therapeutic feeding technique primarily used for medically complex and premature babies whose suck, swallow, and breathe (SSB) reflex is not coordinated or matured, which is essential to bottle-feed without aspirating milk into the lungs.  

The American Academy of Pediatrics (AAP) and global infant feeding guidelines advocate and promote responsive feeding, which is uniquely different from paced feeding.  Full-term, healthy babies are born with their SSB coordination fully developed and can responsive bottle feed safely.

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

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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 and confusing and, in some cases, are 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 →