Tag: Baby-Friendly Hospital Initiative

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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Is Formula More Dangerous than Irreversible Brain Damage?

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Is that some kind of sick joke? Infant formula is safe nutrition—scientifically created to replace human milk and thus consists of fluids and nutrients necessary to nourish a baby. Brain damage is irreversible.  That should be glaringly obvious, but it looks like the AAP Breastfeeding Section responsible for the recently released “Breastfeeding and the Use of Human Milk” (June 2022) has lost sight of this critical fact.

Let’s focus on this appalling statement:

“The need for phototherapy in an otherwise healthy infant without signs of dehydration and/or insufficient intake is not an indication for supplementation with formula unless the levels are approaching exchange transfusion levels.”

Hyperbilirubinemia (excessive jaundice) and Phototherapy

To explain why we are horrified, let’s look carefully at what the statement means. Jaundice is a common and usually benign condition experienced by about 60% of healthy newborns. It is caused by a substance called bilirubin, a breakdown product of fetal red blood cells after birth to transition to mature red blood cells. However, if a baby’s bilirubin levels are greater than a certain level and continue to climb, the risk for brain damage increases.

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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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Belgian Mother Shares How Her Babies Became Lethargic After Being Denied Supplemental Milk by Hospital Staff

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A Letter from Karlyne C. from Belgium

I would like to share my experience in hopes that it can be useful. My name is Karlyne, I am the mother of 3 children and live in Belgium. 

My first daughter, Moïra, was born in 2018. I had not looked up any information about breastfeeding during my pregnancy, I thought that since it is a natural process, it would be easy and that there was nothing more to know than the fact that I should put the baby on breast when she showed signs of hunger. When she was born, that is what I did, I put her on my breast.

But she could not manage to latch on, she would systematically let go of the breast. I asked the midwives who worked in the maternity ward for help. They would crumple my nipples while firmly holding her head to try to shove them in her mouth despite her cries. Hours went by without her being able to feed, and I could tell she was getting weaker; all the while the midwives told me everything was normal. In response to my insistence, I was told to express colostrum in a small spoon and to give it to her if it could reassure me. I produced at most a few drops of colostrum, yet the midwives kept telling me that I had enormous quantities, and that a baby’s stomach is minuscule, that some five halves of those small spoons every 2 to 3 hours would be more than enough. Those few drops, Moïra refused because the spoon in her mouth made her nauseous, so she would not take it.  The midwives refused to bring me a clean spoon for me to try again, telling me that supplementing once was enough. 

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How To Prepare For Supplementing When Breastfeeding Your Baby In The Hospital

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Mothers who experienced delayed onset of milk production or experienced low milk supply with their first baby often contact us for support to try breastfeeding again. They typically have anticipatory anxiety because they have lost trust in their lactation professionals and hospital staff and are unwilling to attempt breastfeeding again without supplementation. They want to know how to supplement their baby until their milk supply becomes sufficient to feed them safely while providing proper breastfeeding stimulation for optimal milk production.

The most common concerns expressed:

  • Fear of the pressure to exclusively breastfeed
  • Fear of failing to breastfeed again
  • Fear of advocating for themselves and their babies while in the hospital
  • Fear of being shamed by hospital staff when wanting to supplement until their milk comes in
  • Fear of being denied formula or not receiving it promptly
  • Triggers from the previous negative breastfeeding experience, such as being touched without consent

Monica writes: “I lost confidence in breastfeeding because I didn’t make enough milk for my first son, who required hospitalization for severe jaundice and a 13% weight loss. I was devastated and furious when the neonatologist told me he was starving. In my birth hospital, my son had been forced to cry from hunger, and I was told my body would make enough milk for him by every lactation consultant and nurse in the hospital. I trusted them. They were wrong! I no longer trusted breastfeeding and decided to pump and bottle feed to ensure he got enough milk. I purposely delivered my second baby at a hospital that didn’t force me to breastfeed exclusively. After starving my son,  I was not taking any chances, and I supplemented my daughter after every breastfeeding session. My breastfeeding experience was the opposite of my son’s, and I remember tearing up several times because she was so peaceful and never cried.  Thankfully I supplemented her because it took five days for my milk to come in. Supplementing saved my breastfeeding journey, and we are still breastfeeding 19 months later.”

 

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