Sarah Christopherson is a mother and the Policy Advocacy Director at the National Women’s Health Network, a non-profit advocacy organization in Washington, D.C. She talks about her breastfeeding experiences and her recent experience in a Baby-Friendly hospital where her child became severely dehydrated and lost 15% of her birth weight while in the hospital. She discusses how policies can negatively affect patient health and how systemic change is needed to support positive patient health outcomes and prevent patient coercion.
John and Kristen are both surgical residents who recently had their first child. This is their story.
By John and Kristen Waters
Let me start by saying we are one of the lucky ones. Our first-born was born at term on July 25th, 2019 at 9:43 p.m., a healthy 7 lb, and 10oz. My wife – a general surgery resident – was planning on beginning to breastfeed right after birth. My wife had undergone a bilateral breast reduction about 15 years ago, so issues with breastfeeding were on our radar. Immediately after birth, we were taken from the delivery room to the postpartum unit, where at 2 a.m. my wife and I were given a pile of paperwork and instructions on breastfeeding practices. All the while both of us were seeing double from the long day and night of laboring and delivery.
Over the course of the next 12-24 hours, our baby attempted to latch and breastfeed, continuing to have issues with falling asleep while on the breast. We spoke with a lactation consultant and multiple nurses who stated that things were going fine and that everything was normal. Over this time the rate of wet diapers continued to decrease and our baby did not have a bowel movement.
As we got into our second night of life, our child began to cry hysterically.
By A Mother from the Fed is Best Community who wishes to remain anonymous
This is my baby girl in NICU. She developed a high fever, jaundice, and dehydration with a 10.1% weight loss 56 hours after birth while exclusively breastfeeding in a ‘Baby-Friendly’ hospital.
During our stay, the hospital pediatrician saw my baby twice a day but he failed to inform us she had a 7.2% weight loss in the 30th hour of life. Hence, we were not given the information to decide if we should supplement with formula.
According to a review published in the Journal Of Family Practice in June 2018, “exclusive breastfeeding at discharge from the hospital is likely the single greatest risk factor for hospital readmission in newborns. Term infants who are exclusively breastfed are more likely to be hospitalized compared to formula-fed or mixed-fed infants, due to hyperbilirubinemia, dehydration, hypernatremia, and weight loss.” They estimated that for every 71 infants that are exclusively breastfed, one is hospitalized for serious feeding complications.
She was always furiously latching and my nipples were cracked and bleeding from constant nursing. She became very sleepy and now I know she was lethargic. Naively, I continued to breastfeed as instructed, and we told everything was fine until she developed a high fever just before discharging. They suspected bacterial infection and my poor baby endured a spinal tap, blood tests, IV glucose, and prophylactic IV antibiotics while waiting for results to come back. There was a very concerned NICU nurse that told me it’s time someone questions the strict exclusive breastfeeding practices of the BFHI. She was the one that told me to look at the weight loss when I was shocked and confused wondering how on earth my little girl caught a bacterial infection. Continue reading
By Dr. Christie del Castillo-Hegyi, M.D.
The Fed is Best Foundation has written about countless cases of serious complications caused by poor standards of breastfeeding management established by multiple exclusive breastfeeding advocacy organizations. The primary causes of these poor outcomes are:
- the persistent denial of the seriousness of newborn weight loss
- the lack of transparency about the consequences of insufficient feeding complications in patient education and health professional training
- and the dangerous obsession with exclusivity in breastfeeding.
Exclusive breastfeeding, according to the WHO, means “the infant receives only breast milk. No other liquids or solids are given – not even water – with the exception of oral rehydration solution, or drops/syrups of vitamins, minerals or medicine.” While breastfeeding is a positive thing to support, the obsession with exclusivity in breastfeeding promotion results in approximately 190,000 newborn admissions a year in the U.S. alone, mostly from complications of jaundice and dehydration caused by underfeeding. This article will discuss the actual reason why exclusively breastfed newborns lose weight and why newborn weight loss is not due to IV fluids given to mothers before delivery. This is to address a commonly circulated unsafe recommendation by exclusive breastfeeding advocates and lactation professionals suggesting we increase the AAP recommended maximum weight loss threshold of 7% and to weigh infants at 24 hours, which would likely increase newborn insufficient feeding complications, hospitalizations, and brain injury.
Part 1: Why a Newborn Loses Weight in the First Days
Let’s start the conversation off with why newborns lose weight in the first days of life. Exclusive breastfeeding advocates have hypothesized that infant weight loss is caused by fluid shifts and “diuresis” or elimination of fluid through urination. Diuresis is defined as overproduction of urine caused by excess body fluid, which should be at least 6-8 wet diapers a day, the normal urine production of a hydrated newborn. In fact, exclusively colostrum-fed newborns, only produce 1-2 wet and dirty diapers a day the first 2 days of life, which is lower than the normal number of wet diapers a day for a hydrated newborn. Therefore, weight loss is not in fact caused by fluid loss.
Here are some basic facts about newborn nutrition:
- The caloric requirement of a newborn from birth through the first weeks of life is 100-120 Calories/kg/day, a figure that is determined by the number of living cells a baby has to keep alive.
- The fluid requirement of a newborn is more variable, which can be affected by how much fluid reserve they are born with. But according to the pediatric literature it is approximately 60-80 mL/kg/day the first 2 days then 100 mL/kg/day thereafter.
- That means a 3 kg newborn needs 300 to 360 Calories per day and 180-240 mL of fluid for the first 2 days and 300 mL thereafter.
By Jody Segrave-Daly, MS, RN, IBCLC
We. listened. to. them.
We validated their stories and offered them compassionate and judgment-free support. We didn’t blame them when they were struggling with their breastfeeding journey. Instead, we apologized for what happened and found a way to help parents breastfeed/chest-feed their babies safely, with confidence and with love. We helped them heal in a safe place while lactivist zealots vehemently judged them and blamed them for not having the right breastfeeding support, the right breastfeeding education, the right nurse, doctor, LC, or hospital. They even blamed mothers for not recognizing HUNGRY signs when their babies were starving while under the trusted care of lactation professionals.
Today begins World Breastfeeding Week 2019.
I want to bring awareness to what we do every day to support breastfeeding parents successfully at the Fed Is Best Foundation. Our goal is to bring awareness to lactation professionals to inform them of what parents are telling us they need to successfully breastfeed because they tell us no one is listening to them. Continue reading
Abridged Comment Presented on July 11, 2019 at the USDA Dietary Guidelines Committee Meeting in Washington, DC
My name is Dr. Christie del Castillo-Hegyi, Co-Founders of the Fed is Best Foundation, a non-profit organization of health professionals and parents whose mission is to research and advocate for safe breastfeeding practices. We do this to prevent the complications of infant dehydration, excessive jaundice, and hypoglycemia from insufficient feeding, all known causes of brain injury, disability and rare deaths. I have come here representing over 700,000 supporters to raise awareness regarding these complications for the DGA committee as they prepare the infant nutrition guidelines.
I am a neonatal intensive care unit nurse (NICU) and the hospital I work at delivering more than 2,000 babies annually, over half from high-risk pregnancies. In our part of the country, “natural parenting” is widely embraced, and it is difficult to find a hospital that isn’t “Baby-Friendly.” Our hospital administration views the Baby-Friendly Hospital Initiative (BFHI) and the 10 steps to successful breastfeeding designation as a marketing tool, hoping new parents will choose our hospital to deliver their babies. Any criticism of the BFHI risks a backlash.
COMPLICATIONS on the mother-baby unit
Since our hospital became BFHI certified, NICU admissions for acute starvation while exclusively breastfeeding have escalated to at least 4 admissions weekly. (It should be zero) Fortunately, once the baby reaches the doors of the NICU, we are free from the BFHI protocol. We are not, however, free from all the indoctrination the parents have already received, and they’ve received an impressive and dangerous amount. We require verbal consent and a physician’s order for donor milk use, but only low birth weight babies qualify for that. We also require a physician’s or Neonatal Nurse Practitioner’s (NNP) order for formula milk use. It is not uncommon for parents to request IV fluids over formula supplementation.
When I first wrote this blog post, I was blown away by how many mothers related to my breastfeeding story. So many women reached out to let me know I wasn’t alone, and shared nearly identical stories. Which made me both relieved, and also very sad that this mental health side of breastfeeding isn’t talked about enough. I don’t understand why so many people act like it doesn’t happen and don’t talk about it. We can SAVE lives if we DO talk about it!
I was just as equally shocked to see how many mothers thought that I should have kept breastfeeding anyway, even if it meant resenting my son, and being nothing more than a food source and a shell of a person. My story has been picked apart by many lactivists, from accusing me of being selfish, to thinking I just didn’t have enough support or encouragement. I had more than enough support for breastfeeding, but very little support for switching to formula when I knew it was best for my own mental health, and for my son. I can’t fathom telling a mom she’d better breastfeed or might as well be dead. I’m not against breastfeeding. I successfully breastfed my second baby for almost a year! But I don’t believe in breastfeeding at all costs, especially at the expense of the mother’s health, and that includes her mental health. A mother’s mental and emotional health are just as important as her baby’s health. Not every mom gets that oxytocin-induced happy breastfeeding experience. Sometimes it’s the opposite, and those moms need support and recognition too.
Christie del Castillo-Hegyi, M.D.
Another day, another distortion pushed by supporters of the Baby-Friendly Hospital Initiative, who no longer have any reasonable justification for endangering newborns with their policies, namely policies that increase the risk of accidental suffocation, newborn falls and starvation-related brain injury from strict exclusive breastfeeding promotion. Never in the history of Western medicine have we had decades of scientific evidence that a public health policy increases the risk of brain injury, disability and death in infants while millions of dollars are used to promote the policies’ “benefits” while actively suppressing knowledge of its risks. Since they no longer have any defense for their unsafe practices, they use the old and tired argument that anyone who criticizes or raises awareness on the safety issues of their policies must be funded and influenced by formula industry.
The most recent attempt to suppress the opinions of its critics occurred on December 18, 2018 when Women’s eNews published a highly biased and inaccurate article aimed at discrediting one of the BFHI’s critics, Dr. Ronald Kleinman, who published an editorial along with two other pediatricians, Dr. Joel Bass and Dr. Tina Gartley, in the medical journal JAMA Pediatrics regarding the serious safety issues associated with the BFHI protocol, entitled, Unintended Consequences of Current Breastfeeding Initiatives.
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