More and more hospitals are adopting the Baby Friendly Hospital Initiative, based on the 10 Steps To Successful Breastfeeding. For women who want to breastfeed, this can be fantastic news – especially in areas where breastfeeding is not the societal norm. It also is positive news for mothers who want to room-in with their babies.
The problem is, though, that these initiatives are billed as good news for everyone; something that is being done for the benefit of all babies and mothers. Framing them this way eliminates any chance of individualized healthcare, often putting the baby’s needs above the mothers, or some mothers’ needs above other mothers’ needs.
It doesn’t need to be this way.
Breastfeeding support is crucial. But so is maintaining personal autonomy. So is support for postpartum mental health. So is a mother’s physical health. So is support for adoptive families. So is support for fathers, so that they are rightly made to feel they have equal responsibility in this child-rearing game, from day one. Until then, parenting will remain an undeniably gendered activity.
I do not believe that Baby-Friendly has to mean mother-unfriendly. I think there are many wonderful things about the 10 Steps. But to put breastfeeding first, instead of on the same level as other aspects of infant care, is misguided.
I asked the women of the Fearless Formula Feeder Facebook community – one that spans over 50 countries, and over twelve thousand people from all walks of life- to answer a question: “What would a truly family-friendly hospital look like?” The responses are below, and I hope that care providers, nurses, politicians, and especially hospital administrators will read these. They range from general policy suggestions, to personal experiences of what works, and what doesn’t, when it comes to maternity care.
Some of these suggestions are cost-prohibitive, of course, or may not apply in certain medical/insurance-based situations. But overall, these are simple requests. Respect. Autonomy. Kindness. A plea for care providers to truly do no harm.
I know we can get there. Many hospitals are already doing this, and doing it well. It can’t be about exclusive breastfeeding rates, and losing funding if you don’t have a specific number of babies leaving without receiving supplementation. It has to be about patient care. Long-term outcomes.
Do no harm. That’s all these mothers are asking.
“I experienced a truly baby and family friendly hospital. The nurses educated me and hubby each day on how to do things to care for our son. Including how to formula feed safely and correctly.”
“My experience was great. The nurses were so helpful and friendly and kind and always willing to help with my latch, etc. I had a hard time meeting with the LC because I was often in the NICU when she made her rounds. but they made sure I got to see her right before I checked out. I did not feel judged with my right off the bat combi-feeding and they were very open to having my husband come into the NICU and feed baby boy when I was too wiped out. I felt like they took care of me and the baby.”
“I gave birth at a ‘baby friendly hospital’ and I was extremely pleased with my experience. The hospital staff made the biggest difference for me. I was given options, and I was never once questioned on my choices nor did the staff feel compelled to “educate” on my decisions. I told a nurse I was struggling with breastfeeding. Her response was a simple and kind ‘Would you like some formula? Or to see a lactation consultant?’ One nurse noticed my son was extremely fussy, and asked if they would like me to take him to the nursery so I could get some rest. Being helpful yet respectful, that’s what a baby friendly hospital should be about. A little bit of tact goes a long way.”
“The hospital that I delivered at… allowed two support people to stay 24 hours a day, and had fold-out chairs provided for them to sleep on. This allowed both my husband and mother to be present before, during and after birth. The number of guests is restricted, and all visitors must be pre-approved by mom. Nurses were amazing – supportive and knowledgeable. We also had access to a lactation consultant. Baby stays in the room with mom at all times, and you are given as much or as little support as you need. Once home, I was visited by the public health nurse, who checked in regarding both the baby’s health and my own, including my mental health.”
“I found both of my experiences to be family friendly. I had the privacy of a private room without extra costs, respect for my decisions, especially with feeding. They were ready to assist with breastfeeding, and when that wasn’t working out, had formula ready and waiting. They encouraged both options without judgment, and made me feel that baby having a full tummy regardless of the method was what was important.”
WHAT DOESN’T WORK
“After baby was born.. it was like I didn’t exsist.. even though I was having medical problems like clotting and depression.. I think there should be a team of nurses that still “make sure your ok.”…He’s got to go home with me.. and I am a hot mess. I had a high grade fever for 2 days…I told them I thought I was and they didn’t check till I was almost released and then I got a big IV of antibiotics.. not to mention, crying all night.”
“I made it very clear when my son was born that I wanted him breastfed, but supplemented as needed. No one gave me any idea how to do so, or saw fit to tell me what he needed, even when he lost 11% of his body weight.”
“I just generally felt like I had no idea what I was supposed to do. I was tired and confused and the only solution I had for anything was check the baby’s diaper, then attach him to the breast to see if that helped. It did, and my OB said it was fine when I saw her in the morning, but I spent all night going, “Oh god am I doing this wrong? It’s 2 AM and I have forgotten what sleep feelings like and I can’t find the light switches to turn out the lights.” And the thing is — I had overall a very positive birth experience! But I felt left alone a lot when I wish someone had been able to offer a bit more general guidance overall. And I don’t know that it’s really possible in current US medical settings, which generally assume your family can step in and be that role.”
“Allowing c-section moms to send their babies to the nursery for a few hours at a time. With baby #3, my hospital started a “rooming in” policy, which they claimed was to enhance bonding, but really it was b/c they are short staffed with budget cuts. My husband had to be home with our girls, so I was left on my own, the same day/night as a major surgery, to try and get in and out of bed, care for the baby, and try to pump. By the second or third night, one of the nurses saw how completely exhausted I was and offered to take the baby to the nursery so I could rest. I am still grateful for her kindness and foresight.”
“Family-friendly means being heard. My daughter refused to feed her first day. I kept saying something was wrong, nurses kept telling me it was normal. She was lethargic from blood type incompatibility jaundice. My boobs were handled by more people than I could count. They had me hand expressing for droplets. It was awful. They found the jaundice at her 24 hour tests and nobody explained it- just stuck her under lights and left us alone. Because I was a first time mom I wasn’t listened to, I was brushed aside.”
“The ability for support people to ‘tag out.’ When our kids were born, Dad got an ID bracelet in the delivery room. Awesome – it meant they knew which baby belonged to which grownup. Great idea. But once that band went on, it meant he was the ONLY person allowed to stay past 8pm (when visiting hours ended). So his choice was either stay to be able to help me, or go home and put the other kids to bed and retain some semblance of usual in their world. It would have been awesome if someone else had been able to come for a couple hours while he did bath and bedtime (even just until 10 or 11) and maybe caught a nap himself.”
“Kangaroo care. Yes, I understand the benefits. But for me, someone who is painfully modest, it was a bit alarming when a nurse ripped open my grown and exposed my body to a room full of students (no warning!) I would have rather swaddled my newborn and shared him with my husband, rather than lying there in the hospital bed for an hour (because it was required, I mean *suggested*) while listening to my new baby cry. They didn’t listen to me when I told them that he needed an immediate bottle for low blood sugar, though they knew I had gestational diabetes….Too many mothers are treated like second class citizens with no apparent needs. This must do wonders for those who will experience postpartum depression.”
“I was told during my birthing class that the hospital highly encouraged rooming in as mother and baby sleep better that way (not true in my case). Even walked us past the empty nursery to show us that most people don’t send the baby to the nursery, so I felt very guilty asking for them to take her for a few hours. I only got 2 hours of sleep a day while in the hospital.”
“Avoiding passive aggressive comments regarding decisions parents have made (I just got a lot of “Well, at least she’s still getting breastmilk” comments from my hospital when I told them I’m pumping instead of breastfeeding her – and she’s in the NICU and can’t even breastfeed yet!). Being able to deviate from a policy when it’s deemed appropriate – I had to watch a video before being discharged about how to care for my newborn. My newborn has a heart defect and is in the NICU and is in fact NOT coming home with us. Having to watch a video about caring for the baby I’m not bringing home kinda sucked. It would have been nice if the nurse could just note that I didn’t watch the video cause it didn’t really apply to me. Plus it was a really outdated and stupid video in general.”
“A true baby friendly hospital experience would not involve nurses or doctors pressuring a new mom into breastfeeding. I spent the first 48 hours of my child’s life listening to nurses telling me that “breast is best” and crying because it wasn’t working for us. I felt like a huge disappointment to my baby. You are celebrating a new life! It should be a joyous time, not a depressing one.”
“I would love to see a hospital that gives a detailed tutorial on how to supplement and when. I had planned on exclusively nursing with my first but when that did not work out I was told to supplement. Well what does that actually mean? I didn’t know and I was so exhausted I didn’t even feel up to researching it so I ended up moving straight to formula. If I had had more help then perhaps I could have nursed longer.”
“I felt pressured to make breastfeeding work and then felt guilty when I requested to start supplementing with formula while in the hospital. They made me sign a form for documentation purposes saying I was educated in the benefits of breastfeeding and only 1 nurse out of my entire 3 night stay post c-section (and she just so happened to be the very last nurse I had prior to discharge) made me feel truly supported & told me it was ok to do whatever I chose and baby would be fine regardless. I think a truly baby/family friendly hospital would be supportive and accepting no matter what feeding method you choose.”
“I would have loved to get some sleep and not have nurses wake me up every two hours. That just gave me such a rough start to parenthood. We actually left the hospital early to get some sleep at home.”
“I would have liked more information on nursing and what that would look like over the first few weeks, as well as things like weight gain and how that was supposed to look. I read a lot about breastfeeding beforehand, and I also went to a breastfeeding class, and they all seemed to emphasize the number of diapers thing but not the normal weight gain range, so it took me a while to realize that my supply wasn’t sufficient. It wasn’t until my SIL, a nurse, told me that my kid should be gaining an ounce a day, not an ounce or two a week, that I realized we had a real problem, not just something that would go away if I nursed constantly. I don’t know how I missed that information when I was weighing her weekly at the public health unit to check on her weight gain, but I did. So more information on supplementing, and when it’s a good idea, and more support for that would have been helpful. Also, not having the doctor who delivered my daughter try to squish my nipple into her (the baby’s) mouth roughly in an attempt to show me how to latch would have been good.”
“(I wish they’d had) an explanation on why they’re encouraging you to do certain things. The reason being, I had preeclampsia so my daughter was born a couple weeks early. I was very sick and had a very hard induced labor. So I was extremely out of it even a day or two after she was born and staying in the nicu. The nurses brought a pump in the room and kept telling me I had to pump but I didn’t understand why I had to do it so soon. I understand it now but at the time I would’ve appreciated an explanation instead of just being given a pump and a deadline.”
WHAT MIGHT WORK
“ I think a family-friendly hospital initiative service would entail 1) LC’s that provide support and education in both breast and safe formula feeding practices minus any rhetoric or ideology promoting one over the other, 2) allowing parents to either room-in with their new babies, or send them to a fully-staffed nursery in case they need some uninterrupted sleep during their hospital stay, 3) provide support and education to new fathers on what to expect, how to become involved in the early days, etc., 4) will provide genuine evidence-based care before, during, and after the birth, 5) supplying parents with resources regarding feeding concerns, emotional support, and physical care for the post-partum stage once the family is sent home.”
“Recognize that mom is also a recovering patient… especially if she’s had a traumatic birth. Babies require a healthy, happy mom to thrive so make sure mom is getting her pain meds on time, help with showering/self care, checks for infection etc….If a mom has decided she is NOT nursing (for whatever reason) don’t continue to send in LCs. It’s already a hard decision. Don’t make it harder for her. Women are smart. Trust that they’ve made the choice that’s right for them.”
“Treating mom like she’s just as important as the baby, especially after delivery (you deliver the baby and suddenly don’t matter at all anymore sometimes). That means factoring in what’s best FOR HER as well as for baby. Providing unbiased information and help for whatever mom (and the family) decides to do. Answering any questions in an unbiased way. Asking questions in an unbiased way (“How are you planning to feed?” rather than “Are you breastfeeding?”). Realizing that giving birth is really hard on your body and that there is a recovery process involved regardless of how you delivered (vaginally, c-section, epidural, natural, etc.) and treating mom like she is in recovery – not expecting her to 100% parent the newborn immediately if she doesn’t feel up to it. Treating moms as individuals – what’s best for one isn’t best for another.”
“Respecting the parents decision on how to feed their baby. No pressure or guilt, the priority should be that the baby is getting fed and thriving, no matter how that gets done.”
“It would involve postpartum nurses being qualified as a lactation consultants and/or having lactation consultants available all the time — including nights and weekends. Formula should absolutely be available if people want it but not if people don’t — respecting people’s choices goes both ways. I firmly believe that if I had had better BFing assistance from the beginning, my child would not have been fully on formula within 2 weeks of birth. I did not appreciate the way an allegedly baby-friendly hospital was actually not particularly helpful with feeding.”
“Support for parents who want to REST, be that a nursery, less intrusions. Formula support as well as breastfeeding support. To be offered formula as an option even if you plan to breastfeed. Have all your care providers be on the same page (no conflicting information). For everything to not be so RUSHED. Help for first timers, be that showing you how to do something or offering guidance/reassurance.”
“A truly friendly baby hospital would start out by asking you what your plan or goals are without injecting their own opinions or tone. If you ask for advice, they would then tell you pros and cons, but again remain neutral. After all, how can a hospital be baby friendly if a mother feels ridiculed or intimidated when stating what she wants? A happy mother equals baby friendly.”
“I think it would allow more than two hours of sleep for a mother who has just given birth, and options for the mother rather than mandated rooming in or nursery. It would offer services such as a kind LC if desired, and if not, training in the use and preparation of formula. It would offer services to new moms such as explaining postpartum depression and when to see someone for it. it would offer rooming in for both parents…”
“Basically it comes down to respecting the family concept and allowing mom and baby to bond while recovering from the rigors of birth offering preference-based options. I think they should educate when a mom seems unsure and ask if they can help clarify with some information to make a decision on. Pushing breastfeeding as hard as they do comes across as hostile to those of us who have no option, and it’s rude. If care providers could have their third trimester patients fill out some preferences ahead of time it would save a lot of trouble. I would much prefer to be asked ahead of time what my plans for infant feeding were, and do I need any additional information on either option, and if I was firm in my decision – not to be preached to by the hospital staff, but rather receive instruction about the choice I made if I indicated such. “
“I avoid “baby friendly” hospitals because they end up being very hostile to women who cannot breastfeed like me, and even more hostile to women who choose not to breastfeed. They need to realize that this woman has just given birth. She needs rest, and she needs to bond with her baby regardless of method of feeding. If she’s a new mother she may need more instruction on caring for baby, but otherwise the constant vitals checks in the middle of the night make for a sleep deprived and exhausted mother upon leaving the hospital. Why can’t they just attach some monitors for the night and let us sleep rather than waking us up every couple of hours?? That has mind boggled me for the longest time.”
“Feeding specialists for both feeding choices. Nurseries where the baby can actually stay for a few hours so parents can rest. Services for mothers who need or want information on PPD.”
“Hospital workers that actually sit down to explain things to you, and give you options instead of scare tactics.”
“Respect and support for new parents. Regardless of their feeding or birth plan choices. Offer information and resources to help them make informed choices that best fit them and their family’s needs.”
“Ask the parents questions: what are their feeding goals? What do they have questions about? Are there areas where they feel like they need support? Take the lead from parents as to where to offer support. Provide unbiased information and support on infant feeding. Check in on mom and baby regularly, and more information provided on postpartum mood disorders and how to get help.”
“There’s so much information on breastfeeding. Yes, it is absolutely wonderful to educate new parents on proper feeding. So where’s the information on formula? There’s nothing (other than “feed him an ounce”). What does that do? Where’s the reading material….well, guilt free reading material. Have these hospitals considered women who have gone through breast cancer? Rape and molestation survivors? Mommies who suffer from depression and need certain medications? Hell, mommies who are in need of many different medications! Or- crazy thought- women who just choose formula? They need information too, for their babies’ sakes. There should be something with answers to frequently asked questions. Burping, dairy allergies, acid reflux, how much, when to increase your child’s formula, generic vs name brand, etc.”
“Respect the mother as both a grown up able to make decisions about her body and her care, and a patient in her own right. BFHI has a nasty tendency to view baby as the only patient and mom as the adjacent milk production unit. What does that mean in practice? A mothers informed choice to formula feed must be respected. Currently FF moms have to fight epic battles with staff to obtain formula and be spared intrusive and unwanted lectures about breastfeeding from every new staff member that enters the room.”
“Mandatory rooming in for all mothers must end. Not giving exhausted mothers any opportunity to sleep at night even if they ask for it is abusive, paternalistic and dangerous to both mom and baby. No sane person would order a day zero surgical patient to look after a baby regardless of the patient saying he can`t cope. Exactly that is standard BFHI procedure for cesarean moms. Things have come so far that maternity ward nurses no longer consider baby care part of their job description. This insanity needs to stop.”
“A truly baby friendly hospital would respect the wishes of the parents in regards to how they want to feed their baby. I went to a hospital where they are exclusively a breastfeeding hospital, they almost yelled at us when we brought formula in for our first son. Offer choices and information to all new parents, and have them decide.”
“Respecting the parents right to choose. Understanding that the parents\family of the new baby might have different beliefs\goals than the hospital\nurse\doctor. The way things are worded in literature from the hospital even if they claim to be supportive it’s really clear what the hospital really thinks.”
“A baby and family friendly hospital would make it a priority to understand what the goals and needs of each family are either before, during, or directly after birth. They would offer education, support, and guidance at ALL times. Trained nurses, doctors, and midwives should value the fact that not every baby, mother, or family is the same, with the same resources, support, and goals. Every mother should leave the hospital feeling like they were given the information, support, time to heal, and time to bond with their baby that they needed. It’s not about breast VS. formula. It’s not about natural VS. medicated. It should be about helping create healthy babies, healthy mothers, and healthy families in every sense of the word.”
“ASKING what your needs and goals are – NOT just slamming what is BEST in your face. Weighing OPTIONS with you (delivery, drugs, feeding, sleeping, etc) in a ‘we offer x, y, & z’ manner instead of ‘our policy is x’ without telling you everything. Covering ALL medical needs -making sure that maternal mental health is JUST as noted and prevalent as physical.”
“The word “mandated” is not part of its vocabulary. Nursery is an option after a difficult birth or c-section, no mandated lectures about breastfeeding, options for early discharge exist for those who feel great and are ready to leave, and the family remains the center of care. Finding out what the family wants/needs is the driver of nursing care and those choices are supported.”
“Allowing a mother to rest after hours of exhausting labor and delivery. You go through the biggest work out of your life, on little to no sleep. So, of course a nap would go a long way. And think of the huge hormonal drop a woman goes through once the baby is born! Hello baby blues!”
“More after care is required. Sending new Mum’s home with planned health worker visits to support breastfeeding or proper instruction on formula as well as looking at Mum’s mental health and Bub’s overall well being.”
“A place where you are listened to. Where fathers are always welcome. Where lactation consultants are available 24/7, and formula freely given upon request – no questions asked. Babies allowed to room in with mums, but a nursery available if requested if mums need sleep.”
“A hospital where the parents are asked what they have chosen instead of “educated” about what the hospital policy says is best. Also, an emphasis on mom’s self care during recovery would be beneficial to the whole family. And last but not least, consolidated room visits by hospital staff so that families have uninterrupted time to rest and bond together. This would mean that the Drs, nurses, administrative, housekeeping, kitchen, and any other staff coordinate their visits into a room within a specific time period. With my first baby I had visitors at every hour of night and day. One woman even refused to leave and demanded that my husband wake me up after he explained that I was sleeping for the first time in over 72 hours and asked her to return later. With my second baby, I kept track of the interruptions and the longest we had alone was 45 minutes. So to summarize that is three things: ask more questions and respect the parents’ answers (instead of trying to educate them until they comply with the hospital standards), help mom take care of her body post delivery, and let the whole family have adequate private time to rest together by limiting the number and duration of room visits.”
“Remember although you’ve dealt with 1000’s of mothers and babies this could be this mother’s 1st experience of all this. Be kind and treat each parent as you’d want to be treated, with kindness, respect and patience.”
“A place where parents can feel supported and receive non-judgemental/unbiased education about baby care including all feeding options. As health professionals we want women to feel empowered to have their own, unique birth experience and be in control of their bodies but after baby is born that seems to go away and we start preaching about what is “best” . To me, we would use the same thinking as we do during labor in a family/baby friendly hospital– have a “baby plan” similar to a birth plan; what are your goals, preferences and concerns as a parent? If you choose to bf, ff, cloth /disposable diaper, room in/ send baby to the nursery for a few hours, love/hate the idea of skin to skin etc we would tailor your plan of care to those preferences so you can get the best care, hospital stay, and education to prepare you for YOUR life at home with a new baby. Smaller nurse to patient ratios so you get that personal care and don’t feel rushed or pressured. Overall, a place where you can feel comfortable and supported without feeling judged so when you are discharged you feel confident and ready to take baby home.”
“Guilt free choices. Offer room in and a nursery, formula and lactation support. A pressure free environment focused on helping new families bond in a way that suits them best.”
A hospital that practices safety first and not based on surveys. A hospital that respects patient choice as long as safety is maintained. No more lying about not having formula, insane contracts to induce guilt and fear over using formula, following APA guidelines for the use of pacifiers, allow moms to sleep through the night unless they just don’t want to, a space for partners to sleep and care for the baby when mom needs rest. And..stop passing off propaganda flimsy “science” as truth just to boost breast at discharge numbers. The biggest thing? Put their money where their mouth is. If breast is so great that it is forced on every mom then offer out-patient follow-up on every delivery with free lactation support as well as newborn care. Call moms to ask about depression, engorgement, infant dehydration and jaundice…the list is long. Forcing people into buying breast is best then when they get home not giving one care if they are ok is just despicable.”
“Family friendly means baby friendly AND mother friendly. It means remembering that the mother is a patient in need of care and support even after the baby is born, and not just a vessel for birth. The mom doesn’t cease being a patient at the moment of delivery. This means that the needs of the mom are honored, from respecting her choice about feeding to giving her adequate medical care and support after delivery. This requires hospitals to do the very things they are currently moving away from: providing formula, cease hassling the mother if she states she does not want to breastfeed, and offer nursery hours to mothers who have undergone c sections or grueling labors and/or those who do not have family or friend in-hospital support. The fact that these simple fixes have been lost in a frantic effort to promote breastfeeding above all else should be a concern to us all.”
“Unbiased informed consent, then respect and support for the choices made after such informed consent. Seems like it should be so simple, but the “unbiased” part seems all but impossible.”
“A place that respects moms choices. A place that allows her to choose times to room in with her baby while giving her the guilt-free option to sleep all she wants and recover. A hospital that makes formula available without a waiver at the choosing of a mother. A hospital that informs a mother of the benefits as wells as the risks of exclusive breastfeeding before lactogenesis and prioritizes the feeding of newborn babies over exclusive breastfeeding. A place that encourages staying at least 72 hours because discharge at 48 hours increases risk of readmission but more importantly increases the risk to the child. A place that doesn’t wake you up every 4 hours for vital signs that you don’t need, time and effort than can better be used weighing your child that is fasting from colostrum-only feeding at least one more time a day. A place that respects the rights of a mother to feed her child however she wants and respects the rights of a crying baby to be fed.”
“Actual accurate information about how to supplement or combo-feed. There is more than one form of combination feeding that works, there are also combination-feeding models that don’t work so well. “
“A place where nothing is ever presented as the “right” way of doing something, but rather for every decision multiple options are presented, with info on the pros and cons of each choice to support informed decision making. Families should be supported in any informed decision they make. The presented pros and cons should be based on established medical research, and if none is available, parents should be told that it’s not yet clear what the exact pros and cons are.”
“Respect for the mother, respect for her choices, compassion and understanding with education if the mother requests it. A family/baby friendly hospital experience would make a new mother feel confident and heard, not made to feel like a failure before she even gets home with her baby. The push for breastfeeding causes significant distress for new mothers who do not want to do it, who can’t do it, and who do not know how. I would like to see all feeding options outlined and explained (without judgement) kind attentive staff to answer questions and concerns and honestly a chance to get a bit of sleep.”