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Take a moment and consider the first time mother who had a prolonged labor, attempted a vaginal delivery only to require a c-section hours later.  There is a high likelihood that this mother had been awake for over 24 hours. Now, she has her newborn exclusively in her hospital room, and while nurses and care staff come in to check on them every few hours, the use of the newborn nursery is discouraged.  Instead this mother, who is both mentally and physically exhausted, will need to do as much skin to skin time as possible while attempting to breastfeed, something that everyone told her would be so “natural” and “easy.” As the frustration mounts when her newborn doesn’t latch well and then begins the normal pattern of wanting to feed hourly (also known as cluster feeding), this new mother is likely running on minimal to no sleep as well as postpartum hormones.  When inquiring about formula or a pacifier, she is then told that those things are really not recommended and that this is all normal. After all, the hospital is “baby friendly” and considering the option of formula would really just be “giving up.” Is this where the pendulum with breastfeeding has swung? Well, for those hospitals going for “Baby-Friendly designation”, it seems that this just might be the case.

“I can assure you that I have not spent 21 years of schooling, 3 years of residency training, 9 years in general pediatric practice, and 9 years as a mother to be unfriendly to babies.”

The Baby-Friendly Hospital Initiative (BFHI) was launched in 2001 in the United States by the World Health Organization and UNICEF with the goal of increasing breastfeeding initiation, exclusivity and duration.  In order for a hospital or birth center to receive this Baby-Friendly designation, the facility must follow the “Ten Steps to Successful Breastfeeding” which includes helping mothers to initiate breastfeeding within 1 hour of birth, offering no food or drink other than breastmilk, practice rooming in 24 hours a day, and to give no artificial nipples or pacifiers to newborns.  The program also requires prenatal education about the benefits of breastfeeding as well as referring breastfeeding mothers to support groups upon hospital discharge.

As a pediatrician and a mother, the name “Baby-Friendly Hospital” leaves a bad taste in my mouth from the get-go.  The name would imply that if you are not following the 10 steps suggested above, that you are NOT “baby friendly.” I can assure you that I have not spent 21 years of schooling, 3 years of residency training, 9 years in general pediatric practice, and 9 years as a mother to be unfriendly to babies.  On the contrary, the longer that I practice medicine, the more firm I am in my belief that there is not just one path to raising healthy children.  

The pressures on new moms is relentless when it comes to breastfeeding, and it is important to acknowledge the mental health toll and possible increased risk for postpartum depression that this rhetoric may cause on new families.”

I think the BFHI fails to acknowledge the possible adverse mental health implications that can come with inferring that breastfeeding is the only way to go if parents want to do what is best for their newborn.  I have seen countless new parents, exhausted beyond belief after 2 days of cluster feeding infants. I have walked into hospital rooms for my morning rounds to find infants co-sleeping on the mother’s chest while sleeping in a hospital bed because as the weary mom explains, “I was told to do as much skin to skin time and to let the baby feed whenever they cried, and I just couldn’t keep my eyes open any longer.”  And then there is the pressure placed on new moms from the social media world of blogs and Facebook groups that, while they might be well intentioned to give encouragement, plant the seed that if you don’t keep going with the breastfeeding and instead “cave in” to giving formula, that you have somehow failed your new, precious bundle of joy. The pressures on new moms is relentless when it comes to breastfeeding, and it is important to acknowledge the mental health toll and possible increased risk for postpartum depression that this rhetoric may cause on new families.

At the end of the day, I always tell new parents that I need a happy, healthy Mommy to get a happy, healthy baby.”

Now, by no means am I advocating for popping a bottle in a newborns’ mouth the moment they enter this world.  I, in fact, encourage all mothers to attempt at breastfeeding, especially early on as the early milk, or colostrum, is “liquid gold” of antibodies and nutrients.  I tell mothers to utilize the help of lactation consultants and nurses while in the hospital to help get a good latch established and to hopefully get off to a great start on their breastfeeding journey.  But a system that essentially shames a mother and makes her feel guilty or not “friendly to her baby” if she chooses to use formula or a pacifier, is not one that is “friendly” to either mother or baby.  

At the end of the day, I always tell new parents that I need a happy, healthy Mommy to get a happy, healthy baby.  For some that will include breastfeeding, and I am absolutely going to support the decision for exclusive breastfeeding as long as there is not a medical reason otherwise.  Both hospitals and pediatricians can encourage breastfeeding without it becoming the sole focus and only outcome measure of the newborn period. It is my goal to make sure that new parents, especially those exhausted new mothers, understand that their worth as a parent or the health of their newborn is not and should never be measured by what is produced or not produced from their breast.  That is how we become “Baby & Mother Friendly.”