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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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.

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Advocating For Lactation Consultant Services When You’re A Fearless Formula Feeding Mom

By: Michelle Klimczak, Registered Nurse, Population and Public Health, with a focus on health equity.

We frame infant feeding success as exclusive breastfeeding, so maybe it’s surprising that I got support with formula feeding through local lactation consultants? In fact, I think the support they offered was exactly the kind of compassion, kindness, and respect that new moms deserve. It’s possible to be inclusive.


When our fourth baby arrived we knew our family was complete, and so I’ve savored every milestone even when it feels a bit bittersweet. He just passed 18 months so a lot of the baby stuff that all 4 of my kids used is now packed up. It’s amazing to think of how I agonized over decisions about strollers and car seats and now those things are just “stuff”. It’s amazing too to think of what was meaningful, like what was actually good advice, what was actually helpful, what was actually supportive. These conversations about support are undoubtedly well-intentioned, but I learned time and time again that there are all kinds of ways to find support for a specific version of mothering, but not much widely available when you don’t match up to that version.

That “version” is largely reflective of the kind of mothering that happens when you have the privileges of wealth, and education, and an able-body, food and water security, and the social status that comes with a hetero-normative/traditional family structure. When you have those privileges, your baby has a pretty good chance of having good outcomes, and so by and large, we try to carry out the practices associated with that version of mothering.

So what happens if you can’t “do the thing”? Well, given that I hold all the privileges I talked about above, it’s quite likely that I never would have had a clue, and could have ascribed my own kids’ greatness to my practices rather than my privileges. But, life has had a way of teaching me big, humbling lessons and as it turns out, it wasn’t that I needed support to do the “right” thing but I did need support (and lots of it) to figure out how to do things differently. All four of my kids were by-and-large formula fed. I desperately wanted to breastfeed because that’s “the thing” but it just wasn’t in the cards. No amount of support would have changed something I couldn’t physically do. The support I needed (and was so lucky to find) helped me figure out the practicalities of feeding and feeling successful.


Tube feeding my baby formula was the best I could do.

It’s tricky though because I think there’s a general impression that feeding supports should exist to minimize formula use, not support it.


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Neonatal Nurse Practitioner Speaks Out About The Dangerous And Deadly Practices Of The BFHI

by Christine K.

When the Fed Is Best Foundation launched two years ago, a few nurses sent us messages about their experiences working in a Baby-Friendly Hospital Initiative (BFHI) hospital. They shared common concerns about watching exclusively breastfed babies crying out in hunger from not enough colostrum while being refused supplementation just so that high exclusive breastfeeding rates were met. Two years later, we now receive messages from nurses, physicians, lactation consultants, and other health professionals, regularly. They express their concerns while asking for patient educational resources. They tell us their stories and they need support and direction on what to do about unethical and dangerous practices they are forced to take part in. We collected their stories and are beginning a blog series on health professionals who are now speaking out about the Baby-Friendly Health Initiative (BFHI) and the WHO Ten Steps of Breastfeeding.

Christine K. is a Neonatal Nurse Practitioner currently working in a BFHI Hospital with 25 years of experience. She has worked in both BFHI and non-BFHI hospitals and talks about her concerns about taking care of newborns in the Baby-Friendly setting.

Regarding Unsafe Skin-To-Skin Practices

In BFHI facilities, skin-to-skin is mandated. The protocol calls for skin-to-skin at birth, for the first hour, then ongoing until discharge. New mothers are constantly told that it is important for bonding, for breastfeeding, for milk production and for temperature regulation of the newborn. Baby baths are delayed for skin-to-skin time and nurses are required to document in detail the skin-to-skin start and end times. There is no education on safety regarding skin-to-skin time, only that it is to be done. I have been responsible for the resuscitation of babies who coded while doing skin-to-skin. One died, and the other baby is severely disabled. Mothers are not informed of the risks of constant and unsupervised skin-to-skin time. Mothers have complained to me that they felt forced to do skin-to-skin to warm up their cold or hypoglycemic infant because they are told skin-to-skin time will help their infant resolve these issues when in fact it doesn’t. There is also no assessment of the mother’s comfort level with constant skin-to-skin. It’s very discouraging to hear staff say things like, “That mother refused to do skin-to-skin,” like it was a crime or an act of child abuse. The judgment is harsh on mothers who fail to follow the protocol. I have noticed that partners are pushed to the side, especially in the first hour of life, not being able to hold their newborn, due to this strict policy. Their involvement has been discounted in the name of the exclusive breastfeeding protocol. Continue reading

Nurses Are Speaking Out About The Dangers Of The Baby-Friendly Health Initiative

When the Fed Is Best Foundation launched two years ago, a few nurses sent us messages about their experiences working in a BFHI hospital. Some of the nurses felt comfortable speaking out because they left their jobs or retired early, as they did not want to be part of the restrictive breastfeeding policies that were implemented. They shared common concerns of watching exclusively breastfed babies being refused supplementation, while babies were crying out in hunger from not enough colostrum which resulted in NICU admissions.

Two years later, we now receive messages from nurses, physicians, LC’s and other health professionals, regularly.  They express their concerns while asking for help and for patient resources. They tell us their stories and they need support and direction of what to do about unethical and dangerous practices 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. Continue reading

Breast Is Best Failed Me And It Failed My Starving Son

My son was born at 8:33 am on a Saturday, delivered vaginally at 36 weeks and 3 days gestation. He weighed 6 pounds 3 ounces and was in the 51st percentile for his gestational age. He latched onto my breast within the first 15 minutes. It was painful for me, but my nurse said his latch was great and that he was eating well. I continued to put him to breast every 3 hours as I had been instructed. We were told that we could see a lactation consultant, but one never came to our room. I was not concerned since we were told he had a great latch and was feeding well.

On Sunday morning, we found out that he had lost weight and that he was suffering from jaundice and would need phototherapy. The medical staff told us that weight loss was normal and that his bilirubin levels were “borderline,” so the photo-therapy was just a preventative measure. Throughout the day he alternated between lethargy and crying. He only voided a few times, and his urine was very dark. His latch was still very painful, but I kept bringing him to the breast to nurse every 3 hours. He never seemed to calm down after nursing.

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The Medical Professionals At The University Of North Carolina Allowed My Baby To Starve

I wish I had done more research about hospital exclusive breastfeeding policies before my son was born. I’m a registered nurse with a Bachelor of Science in Nursing, but my maternity and pediatric experience was limited to nursing school. I was always on the fence about breastfeeding—I said that it was my goal but that we would see, so I hadn’t bought in to the narrative of “Breast is Best”. Still, I expected the medical professionals at the hospital where my son was born to tell me if they thought my baby was starving while attempting to exclusively breastfeed.

I delivered at the University of North Carolina Hospital, a top medical center. I felt reassured that I was in great hands. They were called “baby friendly” after all. I didn’t look into what that meant, and I thought I was well prepared. I was induced after being diagnosed with preeclampsia, but, thankfully, it was caught very early. I was two days shy of forty weeks. I had a long labor, followed by a C-section due to my son’s position. I’m also thirty-five years old, so by all accounts, I was high risk. It also meant I was at risk for late or low breast milk supply.

First, my husband and I were laughed at when we said we planned to use the nursery. Thank God for my husband—he did the baby care and brought our son to me while I was bedridden so that I could breastfeed. I was told the latch was great. I felt confident things were going well. But my son was inconsolable by the time he was forty-eight hours old.

My baby nursed a lot. I was told everything was normal and he was “cluster feeding”. Later, as my training came back to me, I never remembered cluster feeding being a thing. During my training, babies were supplemented when mothers didn’t have enough colostrum babies were supplemented and were taken to the nursery if a parent requested. I went to Duke University, and I rotated through WakeMed. These are excellent hospital systems.ClusterFeeding (1)

I was concerned about my baby’s very dry lips, and I was told not to worry. I asked about the few wet diapers that my son produced. Dismissed. I trusted that the medical professionals had my and my baby’s best interests at heart. I asked if maybe my milk hadn’t come in, and I was told all is well. We went home on the evening of the third day after birth, and my baby was looking jaundiced. He cried a lot, but nursing helped soothe him from crying–sometimes.


We saw the pediatrician the next day, and I found out my son had lost twelve percent of his weight since birth. We did a weighted feed in the doctor’s office, and his weight before and after nursing were exactly the same. My pediatrician, my husband, and I had a conversation about giving the baby formula. My husband and I had already decided we were going to supplement with formula before we saw the pediatrician, and our son’s weight loss confirmed that we were right to do so. We did not hesitate, and he had his first bottle minutes after we got home. He sucked it down, and he was finally calm and content for the first time in days. I tried to pump and barely got anything. My milk eventually came in, but we continue to supplement. His weight rebounded, and he gained well, but I was beside myself knowing that my baby had starved. It shouldn’t have come to that.

I am upset that the nurses (most of whom were fairly new) don’t know the difference between true cluster feeding and starvation. I am livid that no one even suggested formula.


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My Inability to Exclusively Breastfeed Was a Constant Destructive Force in My Life After My Son’s Birth – I Had a Suicide Plan

Written by: Allison Stillwell Young, RN, BSN, Graduate Student and Team leader of the fed is best foundation mental health advocacy team

is an oncology nurse at Vanderbilt-Ingram Cancer Center in Nashville, Tennessee. A graduate of Belmont University, she has spent her entire nursing career between research oncology and behavioral health. After the birth of her older son, she developed anxiety and depression directly related to difficulties she experienced with breastfeeding including low supply and feeding judgment. She discovered Fed Is Best during her recovery from PPD/A and found the Foundation to be indispensable when feeding her younger son. As a researcher and mother living with chronic mental illness, she believes that the treatment for perinatal mood disorders should have evidence basis, and she therefore co founded a large, online pro-science peer support group for those experiencing PMADs in 2016. She sits on the board for the Tennessee chapter of Postpartum Support International and functions as one of their state support coordinators for the Midstate.

I had our second child last Monday. Since that evening, we’ve been supplementing with formula due to the fact that I have insufficient glandular tissue (IGT) and I am not physically able to exclusively breastfeed. Yesterday, our older son wanted to help feed his baby brother a bottle and, while he was helping, my husband took this picture of them that I loved. I made it my profile picture, and the fact that I felt comfortable posting a picture of my sons with a bottle really shows a sea change in my feelings about infant feeding. Because of that picture, I wanted to post my story about lactivism, which is extremist exclusive breastfeeding advocacy, and how it affected my postpartum mental health after my older son’s birth. It’s pretty long, but I hope my story illuminates how The Fed is Best Foundations provides important support for new mothers.

Prior to my Soren’s birth, I really drank the “breast is best” Kool-Aid. I was absolutely convinced that it was the only acceptable way to feed a baby, and that moms who didn’t breastfeed were lazy. At no point did anyone in my birthing or breastfeeding classes tell me that lactation failure was even a thing, and it wasn’t something I learned in nursing school either. I mean, looking back, as someone who has an autoimmune disorder and two long-term mental illnesses, I should have recognized that the breasts are able to fail just like any other part of the body, but it just didn’t cross my mind at all.

A couple of weeks before Soren was born, I went to a lactation consultant to be fitted for a nursing bra, and the lactation consultant asked if I’d had any changes in my breasts during the pregnancy. I had. So I said “yes” and she left it at that.

Later, she would tell me that she recognized I had markers for IGT but that she didn’t want to scare me, so she withheld this important clinical information from me. Continue reading