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

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. Health care 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. 

Non-maleficence: Avoids harm to the parent and/or babies, such as insufficient colostrum/milk intake while EBF. Research shows that 1 in 77 EBF babies are hospitalized from complications of insufficient feeding, and EBF is the most common risk factor for hyperbilirubinemia (excessive jaundice that can impair brain development). Sleep deprivation for parents causes newborn falls and accidental suffocation. Infant feeding should always be discussed using nonjudgmental language and unconditional positive regard to avoid instilling or exacerbating psychological distress. Mental health disorders affect 1 in 5 parents during pregnancy, and the first year after birth, making them particularly vulnerable.

What Do Parents Want?

In the United States, parents have limited or no paid time off from work after childbirth, often directly impacting how they feed their babies. They depend on their employers for job security and medical insurance to provide housing, food, clothing, transportation, and daycare expenses. Not every parent can physically lactate or provide 100% human milk to their baby, and not every parent chooses to breastfeed or chestfeed. In some cases, the parent’s mental or physical health takes priority over exclusive breastfeeding or chestfeeding.

Parents have told us they need individualized and unbiased infant feeding support that prioritizes their own and their baby’s safety, honors their bodily autonomy, prioritizes optimal parental mental health, and supports how they wish to divide infant feeding responsibilities with their partners. They want to receive support that leaves them confident with their chosen infant feeding method. 

We believe that they deserve no less.

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

  1. Implement an inclusive infant feeding policy that is routinely communicated to staff and parents,  prioritizes infant safety, parental rest, and recovery, and protects parental mental health. Monitor and publicly disclose the hospital or institution’s infant feeding complications and readmissions rates.
  2. Ensure that all medical staff has up-to-date knowledge, competence, and skills to support breastfeeding, formula feeding, pumping, supplementing, and combination feeding. 
  3. Discuss all feeding options with expectant parents without judgment or bias at every interaction. Provide education about the differences between all feeding options, so parents can be fully informed to choose the feeding method that works best for their family.
  4. Facilitate immediate and uninterrupted skin-to-skin contact, if desired. Support parents to initiate feeding within the first hour of life or as soon as parent and baby are medically stable.
  5. Teach parents how to initiate breastfeeding and how to maximize their milk supply and manage common breastfeeding or chestfeeding difficulties. Educate them on how to supplement, pump, and combination feed as needed or desired by parents. Teach them how to prepare infant formula safely and bottle-feed their baby responsively.
  6. Ensure affirmative consent before touching the parent’s breasts, nipples, or body with every encounter.
  7. Enable parents and their infants to remain together 24 hours a day if desired; provide A well-baby nursery for those who want to use it for rest, recovery, or any other reason requested by the parents.
  8. Support parents in recognizing and responding to their infant’s hunger and fullness cues. Educate parents on the importance of feeding a baby until they are satisfied after every feeding.
  9. Provide information to parents about feeding devices such as bottles, nipples, pacifiers, and breast pumps. Educate parents about the types of formula available and how to prepare infant formula safely.
  10. Coordinate discharge by providing parents with community feeding support groups and resources that support their feeding method.  A follow-up pediatrician appointment should be made at discharge for ongoing feeding support.

Hospitals must have policies to support ethical infant feeding.

Resources:

Breastfeeding Support Guided by Swanson’s Theory of Caring – PubMed (nih.gov)

Infant formula feeding practices and the role of advice and support: an exploratory qualitative study – PubMed (nih.gov)

The impact of Baby Friendly Initiative accreditation: An overview of systematic reviews – PubMed (nih.gov)

The supporting role of the midwife during the first 14 days of breastfeeding: A descriptive qualitative study in maternity wards and primary healthcare – PubMed (nih.gov)

My “Baby Friendly” Hospital Harmed My Baby: How Hospitals Can Do Better | National Women’s Health Network (nwhn.org)

The impact of Baby Friendly Initiative accreditation: An overview of systematic reviews – PubMed (nih.gov)

Autonomy for Mothers? Relational Theory and Parenting Apart by Susan B. Boyd :: SSRN

Breast Is Best . . . Except When It’s Not – Lynne M. McIntyre, Adrienne Marks Griffen, Karlynn BrintzenhofeSzoc, 2018 (sagepub.com)

Well-Informed and Willing, but Breastfeeding Does Not Work: A Qualitative Study on Perceived Support from Health Professionals among German Mothers with Breastfeeding Problems – PubMed (nih.gov)

Women’s advice to healthcare professionals regarding breastfeeding: “offer sensitive individualized breastfeeding support”- an interview study – PubMed (nih.gov)

Professional and non‐professional sources of formula feeding advice for parents in the first six months – PMC (nih.gov)

A Qualitative Study of Breastfeeding and Formula-Feeding Mothers’ Perceptions of and Experiences in WIC – PubMed (nih.gov)

Could the Baby-Friendly Hospital Initiative be hurting mothers—and babies too? (advisory.com)

Do ‘Baby-Friendly’ Hospitals Work for All Moms? – The New York Times (nytimes.com)

A Lack of Evidence for Baby-Friendly Hospitals (undark.org)

Nurses Are Speaking Out About The Dangers Of The Baby-Friendly Health Initiative – Fed Is Best

Letter to Doctors and Parents About the Dangers of Insufficient Exclusive Breastfeeding and the Baby-Friendly Hospital Initiative – Fed Is Best

 


Our mission statement is:

The Fed Is Best Foundation works to identify critical gaps in the current breastfeeding protocols, guidelines, and education programs and provides families and health professionals with the most up-to-date scientific research, education, and resources to practice safe infant feeding with human milk, formula, or a combination of both.

Above all, we strive to eliminate infant feeding shaming and preventable hospitalizations for insufficient feeding complications while prioritizing perinatal mental health.

 

 

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

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, confusing and in some cases are the reason 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

My Breastfed Baby Starved While Under The Care Of Health Professionals For 5 Weeks

My beautiful baby girl Mary-Kate was delivered by emergency c-section, and although there were complications during labor, she was healthy on arrival. Having done a bit of research and listened to the advice of professionals, as well as the threat of the global pandemic posing a risk, I decided I would breastfeed my daughter, to provide her with passive antibodies for COVID-19 from my milk.

I began exclusively breastfeeding in the hospital and the midwife said Mary-Kate had the perfect latch. I loved being a mummy, I could not stop looking at this beautiful little human me and my partner had created, but Mary-Kate was becoming increasingly unsettled. She was almost always attached to my breast and would fall asleep soon after latching on. I spoke to the health visitors, and we were told her crying was colic.  We began giving Mary-Kate lots of colic-type remedies. 

Each time somebody came to weigh her whether it be the GP, HV, or Midwife, Mary-Kate was not gaining and was in fact losing weight. I could not understand, because she was ALWAYS feeding. Nobody seemed alarmed by this. I was told to just keep trying, she might be a ‘slow starter’. Never once did they check to see what my milk supply was or how much she was getting. The professionals would leave, and I would carry on as normal. Baby attached to the breast, me trying to maintain some sort of order in the home, taking care of my personal needs and sleep. Mary-Kate would just cry and cry and cry unless asleep at my breast.  I was exhausted, I was falling asleep whilst holding my baby and I knew this presented its own risks.  Continue reading

Dear Chrissy Teigen, You Are Right; We Need To Destigmatize Formula Feeding Our Babies

Dear Chrissy Teigen,

Thank you for your Twitter post raising the very important topic of stress, guilt, and sadness when a breastfeeding mother experiences low milk production.  

I could feel the deep despair you expressed through your words because I have supported thousands of mothers, just like you, who felt tremendous guilt and stress when they tried their best to make enough milk.

Can I emphatically tell you something? You and your body did not “fail” with making enough milk. You were failed by the current breastfeeding education and guidelines, which don’t fully inform mothers about their biological and psychosocial risk factors for low milk supply. Instead, parents are taught that every mother can make enough breast milk if she has the right support; but the research tells us that low milk supply is far more common than people realize.   All of the support in the world cannot increase breastmilk supply if your body cannot biologically produce it!       

Continue reading

The Letter Not Only Protected Me; It Protected The Nurses Too

The Letter was from my psychiatrist. It was our way of beating a system that neither of us agreed with, or believed was good for my mental health. It provided protection for me to make decisions that went against the Baby-Friendly Hospital mandates. 

The amount of stuff a pregnant woman brings to the hospital for delivery gets progressively smaller, the more children she has. With my first child, I brought three bags; I ended up ignoring 90% of the contents and gave my husband fits when he loaded the car for the ride home. By the time I packed the hospital bag for my third child, everything fit neatly into a small duffel. Even then, I felt like I was overpacking. As long as I had a phone charger, some lip balm, and the Letter, I knew I’d be fine. 

Continue reading

I Am Back From My Breastfeeding Battle And Here’s What I Have Learned

Hopefully, my experiences will help another family avoid the psychological trauma that I endured while breastfeeding my daughter. This is what I learned:

  • Sacrificing your mental health or your baby’s health (or both!) to exclusively breastfeed is not worth it. 
  • Some breastfeeding advocates don’t see (or don’t want to see) the risks of exclusive breastfeeding which include a baby who isn’t gaining weight sufficiently, an emotionally suffering mum, or a strained mother–baby relationship.  
  • Seek help from lactation professionals who are open-minded enough to suggest combo-feeding as an option and are willing to support your choice because sometimes exclusive breastfeeding is not an option.

Continue reading