Baby Friendly Hospitals

Whoever came up with the term baby friendly hospitals is very, very good at their job. It sounds good. Why wouldn't we want a hospital to be baby friendly? What could possibly go wrong?

As we have seen in the years since this initiative came to the US - many, many things could go wrong and most of them are to the detriment of the mother.


Here are the ten steps listed in the World Health Organization Baby Friendly Initiative:

1.Have a written breastfeeding policy that is routinely communicated to all health care staff.

2. Train all health care staff in skills necessary to implement this policy.

3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within a half-hour of birth.

5. Show mothers how to breastfeed and how to maintain lactation, even if they should be separated from their infants.

6. Give newborn infants no food or drink other than breast milk unless medically indicated.

7. Practice rooming-in - allow mothers and infants to remain together - 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.



I asked some birth professionals and moms about how the initiative is actually being implemented and got very impassioned responses from mamas across the country.

The World Health Organization made steps ONE and TWO - creating a policy on breastfeeding that the ENTIRE staff knows and regularly reviews and that the entire health care staff CAN TEACH to new mom. And yet, the steps most commonly implemented first are: get rid of the nursery and throw out the pacifiers. Steps SEVEN and TEN. Moms have screaming, hungry babies; staff isn't properly trained to help them feed their babies from the breast. Yes, they can give their babies formula. No, they cannot rest alone, because there is no nursery. The bond that is supposed to be forming between mother and baby, strengthened by rooming in, is now weakened by rooming in. The more stressed they become, the more difficult it is to initiate feeding. But the nurses continue to arrive, every two hours, to stare at the new mom and her new baby, as they try again. I knew, when I left the hospital, that I would go to a practice devoted entirely to breastfeeding, and I knew that its staff was devoted to helping my baby and me stay calm and keep perspective. We would not be evaluated in ounces or time charts.

Anne-Marie Lindsey, HBCE



I left the hospital feeling completely unsupported. There were no nightly checks on us (me or her). None of my concerns were addressed. My well-being was ignored. My mental health was ignored. I was asked five or six times what my birth control plan was and if I wanted pain medicine but nothing regarding how I was really doing. I asked for a lactation consultant that never came. Cracked and bleeding nipples after less than 24 hours of nursing were dismissed with no ideas on how to heal them or to keep it from happening again. When I asked for help, I got brief assistance and then was completely left alone--no follow-up.



My experience is actually more a statement on my local hospital NOT following baby-friendly protocol (even though it's a designated "baby-friendly hospital." My second kiddo hit the magic number of losing 10% of her birth weight, and the night nurse (at 2 frickin' AM!) started talking to me about supplementing with formula. When I voiced my opposition to this, she and baby's pediatrician came in later that morning and basically made me feel like a horrible person for not agreeing with them. I was so glad when my day nurse came back on shift and suggested they find me a pump! My kiddo will be 4 in November, and I still feel angry at them and at myself for giving any formula to her.


My experience at a baby friendly hospital left me and my husband feeling very angry and isolated as we let staff know of our preferences and received little support.  I had chosen not to breastfeed long before delivery and was confident in my decision.  I let my nurses know as soon as I could that I wanted formula and didn't want to discuss breastfeeding - my mind was set.  After my son's birth we had to wait close to half an hour for formula to be brought.  This trend continued at every feeding; I'd be left waiting - ringing to call button for formula as I'd been told to.  Eventually, a nurse would quickly bring me formula and move onto the next room.  At every shift change the topic of my decision not to breastfeed came up.  Nurses would ask "can you tell me why?" Or "what influenced your decision?"  I even had one nurse tell me "well we expect that in second time moms, but most first time moms at least want to try".



The communication is the key, I feel, because I don't believe nurses want to PUSH anything, I think sometimes their attempts to educate are misinterpreted, or lacking in some way. Nurses don't get bonus points for convincing a mom to breastfeed. But, they are required to ask, and make sure mom has the info. All they NEED to say is "do you plan to breastfeed? ..... has anyone talked to you about the benefits?" If mom says "yes." Then, "ok. That's great." If mom says "No..." they can offer some info. Moms should NOT feel pressured, but it's difficult, because with all the "Mommy wars" stuff, we almost always feel like we are being judged for our choices (or non-choices) even if we're not.



The hospital where I delivered my first kiddo wasn't designated "baby friendly," but here's my experience regarding nurseries: I never once thought I would be the kind of parent who would send their newborn to the nursery. Then I went into labor in the evening (so my husband and I had already been awake all day), and baby wasn't born for another 34 hours - which includes 6 hours of pushing and then a cesarean. I was beyond the point of exhaustion and had very little interest in my baby. The moment they wheeled me into my room, I asked them to take her to the nursery so my husband and I could rest. An hour or so later, he had to drive home in a blizzard because my brother-in-law had the wrong key and couldn't get into our house to feed our cats - definitely something he wouldn't have been able to do had baby not gone to nursery, and I definitely would not have been able to take of baby on my own during that time without a rest first either.


While I was pregnant with my first baby a friend of mine, who is a nurse, gave me some advice. She said to find the oldest nurse on my floor, watch everything she does and take all of her advice. For me that was Ann. She wasn't my nurse, she was the baby's nurse - but she is the first person who asked how I was feeling and not just what my pain level was. She is the one who told me that I could ask them to take him to the nursery at night and bring him in only to feed. I had no idea that was an option. After a traumatic birth, including an emergency c-section, I had mounting anxiety. I also had a lot of family in the room all day long. Night was the only time I could rest, but I spent all night the first two nights staring at him to be sure he was still breathing. Ann saw a woman recovering from major abdominal surgery who hadn't slept in days. She offered me support. When I looked at her with tears in my eyes and said, " You can do that? Really?" She told me something that I would hold on to for years - "If you are okay, then he will be okay. So let's get you better."


Hospitals across the country are closing down their well baby nurseries. In the meantime the rates of c-section are holding steady. Single mothers, women with partners who work nights, women with partners who need to stay home to take care of other children, SO MANY WOMEN are being put in a position where the only time they will have to be cared for and supported while they make this serious transition is being stripped away.

Even implemented in the most gentle way possible those guidelines require an exhausted woman who needs help and support to be questioned and lectured to. How 'baby friendly' is a traumatized mother?

There's also some debate over whether any of this is truly necessary. The WHOBFI is a global initiative and it seems to be working well in many countries. It is saving the lives of babies around the world and that is an amazing thing. Here in the US it seems to have been corrupted by rules and marketing and money - and it may not actually scientifically sound. There's even some evidence that it actually may not be so baby friendly after all.

I had a radical idea. What if instead of focusing on checklists and grant money and percentages - we focused on creating holistic plans, training and supporting nurses so that they can educate and support moms, and respecting the choices of mothers. This simply isn't working for a lot of mothers. We must do better.

Graeme Seabrook